Pregnant Women with Epilepsy Need More Perinatal and Maternal Support: Study

Pregnant women with epilepsy face a higher risk of serious side effects and death, which potentially could be avoided with better medical care, according to the findings of a new study.

In a study published on August 5 in the journal JAMA Neurology, a team of multinational researchers, led by Dr. Neda Razaz, discovered that pregnant women with epilepsy who use medication for the condition are four times more likely to die than those without the disorder.

The researchers also found that the women’s unborn children were more likely to die during the pregnancy and after birth, as well as facing an increased risk of suffering other serious side effects.

Epilepsy is a brain disorder that results in abnormal nerve activity, which can lead to seizures. It can be caused by genetic disorders or brain injury. The condition is often treated with medications, but surgery, dietary changes, and some medical devices can also be used.

Prior research has shown pregnant women with epilepsy face a higher risk of suffering side effects such as preterm labor, premature birth, decreased oxygen to the fetus, slow fetal heart rate, and low birth weight. However, the new research indicates a higher risk of death for both the mother and the infant than previously believed.

Epilepsy Drug Concerns

Drugs like Depakote (valproate), Topamax (topiramate) and Lamictal (lamotrigine) are often prescribed to women suffering from epilepsy, especially during pregnancy, where a sudden seizure could result in injury to the mother and child. However, side effects of using the drugs during pregnancy, particularly Depakote, have previously been linked to a number of potential health concerns, primarily involving unborn children who have been found to be more likely to experience birth defects after exposure to the medication before birth.

In April 2018, the U.K.’s Medicines and Healthcare products Regulatory Agency (MHRA) barred doctors in that country from prescribing Depakote to women of childbearing age unless they are on a pregnancy prevention program.

According to the MHRA, up to 40% of babies born to mothers who take Depakote are at risk of developmental disorders, and 10% are at risk of birth defects.

Abbott Laboratories and AbbVie, a subsidiary it spun off, have faced hundreds of Depakote lawsuits in prior years, involving allegations that the drug maker failed to warn women and the medical community about the risks associated with using Depakote during pregnancy.

Pregnancy Epilepsy Risks

In this latest study, Razaz’s team conducted a population-based study in Denmark, Finland, Iceland, Norway, and Sweden. The study included data from more than 4.5 million pregnant women and looked at births at 22 weeks of pregnancy or later from 1996 to 2017.

Out of the millions of pregnancies examined, more than 35,000 expecting mothers had epilepsy, and researchers determined they faced a considerably higher risk of serious side effects and an increased risk of death during pregnancy and postpartum.

According to the findings, pregnant women with epilepsy taking anti-seizure medication faced a 23% higher risk of suffering life-threatening complications, such as severe preeclampsia, eclampsia, blood clots, stroke, and severe mental health conditions. They also faced four times the risk of dying during pregnancy or postpartum compared to women who did not have epilepsy.

The fetuses and infants of women with epilepsy also faced a 20% greater risk of dying before birth or just after birth. They also faced a 50% higher risk of suffering serious complications like severe brain damage, neonatal convulsions, respiratory distress syndrome, retinopathy, and being born prematurely.

Infants born to women with epilepsy who were taking more than one type of anti-seizure medication faced more than twice the risk of death and serious side effects. Some of the most common medications used by expecting mothers included Lamictal XR, Tegretol XR, and Epival.

Razaz’s team concluded that while most women with epilepsy experience uncomplicated pregnancies, more research is needed to better understand how the condition impacts pregnancy. They also determined there is an urgent need for prenatal counseling and support, as well as monitoring during pregnancy and specialized care during deliveries for women with epilepsy.