Pregnancy characteristics and adverse outcomes in offspring of women with epilepsy: a prospective registry study from Mainland China

Rui Li; Qian Chen; Xing Cao; Hua Yan; Pei Wang; Qun Huang; Xiaoyi Li; Fang Chen; Yangchao Li; Qingxia Kong; Chonglun Guo; Qi Zhang; Qiulei Hong; Yong Liu; Xiaoli Xiong; Yanbing Han; Xiaohua Xiao; Kuiyun Wang; Xunyi Wu; Xi Zhu; Qing Zhang; Lei Chen

doi:10.3389/fneur.2023.1195003

Pregnancy characteristics and adverse outcomes in offspring of women with epilepsy: a prospective registry study from Mainland China

Front Neurol. 2023 Aug 11:14:1195003. doi: 10.3389/fneur.2023.1195003. eCollection 2023.

Authors

Rui Li¹, Qian Chen², Xing Cao³, Hua Yan⁴, Pei Wang⁵, Qun Huang⁶, Xiaoyi Li⁷, Fang Chen⁸, Yangchao Li⁹, Qingxia Kong¹⁰, Chonglun Guo¹¹, Qi Zhang¹², Qiulei Hong¹, Yong Liu¹³, Xiaoli Xiong¹⁴, Yanbing Han¹⁵, Xiaohua Xiao¹⁶, Kuiyun Wang¹⁷, Xunyi Wu¹⁸, Xi Zhu¹⁹, Qing Zhang²⁰, Lei Chen¹

Affiliations

¹ Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
² Department of Clinical Research Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
³ Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
⁴ Department of Neurology, Jianyang People's Hospital, Chengdu, Sichuan, China.
⁵ Department of Neurology, Xianyang First People's Hospital, Xianyang, Shanxi, China.
⁶ Department of Pediatrics, The WenJiang Maternal and Child Health Hospital, Chengdu, Sichuan, China.
⁷ Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China.
⁸ Department of Neurology, Panzhihua Central Hospital, Panzhihua, Sichuan, China.
⁹ Department of Neurology, The First Affiliated Hospital of Dali University, Dali, Yunnan, China.
¹⁰ Department of Neurology, Affiliated Hospital of Jining Medical College, Jining, Shandong, China.
¹¹ Epilepsy Center, Suichuan County People's Hospital, Suichuan, Jiangxi, China.
¹² Department of Neurology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, Sichuan, China.
¹³ Department of Neurology, The First Affiliation Hospital of Xi'an Jiaotong University, Xian, Shanxi, China.
¹⁴ Department of Neurology, Guangyuan Mental Health Center, Guangyuan, Sichuan, China.
¹⁵ Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
¹⁶ Department of Geriatric Medicine, Shenzhen Second People's Hospital, Shenzhen, Guangzhou, China.
¹⁷ Department of Neurology, The Jintang First People's Hospital, Chengdu, Sichuan, China.
¹⁸ Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
¹⁹ Department of Neurology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China.
²⁰ Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.

Abstract

Objective: This study aimed to explore the influencing factors of adverse outcomes in the offspring of women with epilepsy (WWE) and to analyze the changes brought about by the epilepsy knowledge popularization campaign in China (EKPCIC).

Methods: This nested case-control study focused on WWE and their offspring from a female epilepsy cohort in mainland China. From January 2009 to August 2022, WWE was prospectively enrolled in 32 study centers. This study aimed to observe the health outcomes of their offspring within 1 year of age. The main outcome measure assessed the health status of the offspring within their first year of age. We aimed to analyze the effects of seizures, anti-seizure medicines (ASMs), and a lack of folic acid supplementation on adverse outcomes in the offspring of WWE and to explore the changes in perinatal management and adverse outcomes of the offspring after dissemination of the EKPCIC in 2015. Additionally, subgroup analyses were conducted to compare seizure control during pregnancy between the valproate and non-valproate groups.

Results: In total, 781 pregnancies in 695 WWE were included, of which 186 (23.69%) had adverse outcomes. The National Hospital Epilepsy Severity Scale score, number of seizures, status epilepticus, ASM type, and valproate and folic acid doses were associated with a high risk of adverse outcomes. After the EKPCIC, the use of ASMs (P = 0.013) and folic acid (P < 0.001), the seizure-free rate during pregnancy (P = 0.013), and the breastfeeding rate (P < 0.001) increased, whereas the incidence of complications during pregnancy decreased (P = 0.013). However, there was no significant difference in the incidence of adverse outcomes between the analyzed offspring pre-/post-EKPCIC. Additionally, there was no association between the frequency of seizures at different time points during pregnancy and the use of valproate (F = 1.514, P = 0.221).

Conclusion: Possible factors influencing adverse outcomes in the offspring of WWE include seizures, type and number of ASM usage, and a lack of folic acid supplementation. Although the management of WWE during pregnancy is now more standardized, further efforts are needed to reduce adverse outcomes in offspring.

Keywords: adverse outcome; anti-seizure medicine; seizure; valproate; women with epilepsy.

Grants and funding

Med-X Center for Informatics funding project provided fund (YGJC001).