PREGNANCY OUTCOME AND EARLY DEVELOPMENT OF OFFSPRING IN WOMEN WITH EPILEPSY

Abstract

Objectives: The aim of the study was to evaluate the outcome of pregnancy and early development of offspring, in women with epilepsy (WWE) who were receiving and not receiving anti-epileptic drugs (AED). Methods: Women with epilepsy who delivered in a teaching hospital (n=60), between November 2017 and October 2018, were identified from the delivery records (n=5202) and their infants (n=39) underwent developmental assessment by Baroda development screening test. Maternal epilepsy syndrome, AEDs during pregnancy, and other details were obtained from medical records and interview. Results: Fourteen mothers received monotherapy, 15 polytherapy and 10 mothers were not taking any AED. There were four major congenital malformations (MCM) among 39 babies. Two were cardiac malformations; one was complex anomaly, caused death in neonate and other was ventricular septal defect (VSD). Both occurred in babies of mothers receiving clobazam in combination with oxcarbazepine and levetiracetam, respectively. There were two urological anomalies in babies unexposed to AEDs. When mothers were receiving monotherapy (14), normal Development Quotient score (DQ score) was observed in 11 babies, but low DQ score was observed in three. In the polytherapy group (15), normal DQ scores were found in five and low DQ in nine (one baby died neonatally). Among the group who were unexposed to AED (10), normal DQ score was found in eight, but low DQ in two (in the antenatal period mother of one of the low DQ babies reported frequent major seizures). Conclusion: Clobazam therapy is a risk factor for developing MCM in babies of WWE. Oxcarbazepine, monotherapy or polytherapy, and Clobazam polytherapy are risk factors for low DQ scores in the offspring of WWE. Polytherapy and frequent seizures during pregnancy are also risk factors for low DQ scores. Widely used drugs which were considered safe demonstrated adverse effects in offspring. Even though sample size is small, it is a matter of concern and curiosity.