TY - JOUR
T1 - Pregnancy, antiseizure medications and unexplained intrauterine foetal death
AU - Vajda, Frank J.E.
AU - O'Brien, Terence J.
AU - Graham, Janet E.
AU - Hitchcock, Alison E.
AU - Perucca, Piero
AU - Lander, Cecilie M.
AU - Eadie, Mervyn J.
N1 - Funding Information:
We are grateful to professional and lay colleagues and to various lay bodies for referring patients to the Raoul Wallenberg Australian Pregnancy Register of Antiepileptic Drugs, and to the Scientific Advisory Board and the Ethical Research Committees of St. Vincent's Hospital, Monash Medical Centre, the Royal Melbourne Hospital and other institutions for their successive ethics oversight of the APR. The Epilepsy Society of Australia, Epilepsy Action Australia, the Royal Melbourne Hospital Neuroscience Foundation, the NHMRC, and the pharmaceutical companies Sanofi-Aventis, UCB Pharma, Janssen-Cilag, Novartis, Sci-Gen, Eisai, and Genzyme have provided financial support towards maintaining the APR at various stages of its existence.
Funding Information:
We are grateful to professional and lay colleagues and to various lay bodies for referring patients to the Raoul Wallenberg Australian Pregnancy Register of Antiepileptic Drugs, and to the Scientific Advisory Board and the Ethical Research Committees of St. Vincent’s Hospital, Monash Medical Centre, the Royal Melbourne Hospital and other institutions for their successive ethics oversight of the APR. The Epilepsy Society of Australia, Epilepsy Action Australia, the Royal Melbourne Hospital Neuroscience Foundation, the NHMRC, and the pharmaceutical companies Sanofi-Aventis, UCB Pharma, Janssen-Cilag, Novartis, Sci-Gen, Eisai, and Genzyme have provided financial support towards maintaining the APR at various stages of its existence.
Publisher Copyright:
© 2024
PY - 2024/4
Y1 - 2024/4
N2 - Objective: To assess the role of antiseizure medication (ASM) regimens and other factors in relation to the occurrence of intrauterine foetal death (IUFD) in pregnant women with epilepsy (WWE) enrolled in the Raoul Wallenberg Australian Pregnancy Register of Antiepileptic Drugs (APR). Results: IUFDs occurred in 70 (3.01 %) of 2,323 prospective pregnancies from WWE with known outcomes in the APR. Factors associated with IUFD occurrence included older maternal age, enrolment in the APR at an earlier stage of pregnancy, history of pregnancies which did not result in livebirths, parental history of foetal malformations, and maternal use of carbamazepine, lamotrigine or ethosuximide. Individual ASM dosages were not associated with IUFD occurrence. Relative to no exposure, the risk of IUFD increased with the increasing number of ASMs used in combination (2 ASMs: relative risk, RR = 5.45 [95 % CI: 0.73–41.80]; 3 ASMs: RR = 10.70 [95 % CI: 1.27–90.17]), >3 ASMs: RR = 10.70 [95 % CI: 1.27–90.17]), but this finding was attenuated after adjusting for other factors implicated in IUFD occurrence. Several ASM pairs were associated with an increased risk of IUFD relative to no exposure, but these associations were lost after accounting for confounders. Conclusions: Although it is possible that prenatal ASM exposure may increase the risk of IUFD, other non-pharmacological factors are more relevant to the occurrence to IUFD in pregnant WWE.
AB - Objective: To assess the role of antiseizure medication (ASM) regimens and other factors in relation to the occurrence of intrauterine foetal death (IUFD) in pregnant women with epilepsy (WWE) enrolled in the Raoul Wallenberg Australian Pregnancy Register of Antiepileptic Drugs (APR). Results: IUFDs occurred in 70 (3.01 %) of 2,323 prospective pregnancies from WWE with known outcomes in the APR. Factors associated with IUFD occurrence included older maternal age, enrolment in the APR at an earlier stage of pregnancy, history of pregnancies which did not result in livebirths, parental history of foetal malformations, and maternal use of carbamazepine, lamotrigine or ethosuximide. Individual ASM dosages were not associated with IUFD occurrence. Relative to no exposure, the risk of IUFD increased with the increasing number of ASMs used in combination (2 ASMs: relative risk, RR = 5.45 [95 % CI: 0.73–41.80]; 3 ASMs: RR = 10.70 [95 % CI: 1.27–90.17]), >3 ASMs: RR = 10.70 [95 % CI: 1.27–90.17]), but this finding was attenuated after adjusting for other factors implicated in IUFD occurrence. Several ASM pairs were associated with an increased risk of IUFD relative to no exposure, but these associations were lost after accounting for confounders. Conclusions: Although it is possible that prenatal ASM exposure may increase the risk of IUFD, other non-pharmacological factors are more relevant to the occurrence to IUFD in pregnant WWE.
KW - Antiseizure medications
KW - Carbamazepine, lamotrigine
KW - Intrauterine foetal death
KW - Stillbirth
UR - https://www.scopus.com/pages/publications/85186725795
U2 - 10.1016/j.yebeh.2024.109724
DO - 10.1016/j.yebeh.2024.109724
M3 - Article
C2 - 38442517
AN - SCOPUS:85186725795
SN - 1525-5050
VL - 153
JO - Epilepsy & Behavior
JF - Epilepsy & Behavior
M1 - 109724
ER -