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Le Guern V, Rossignol M, Lepercq J. [Indirect causes of maternal deaths (except stroke, cardiovascular diseases and infections) in France 2016-2018]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:268-272. [PMID: 38373491 DOI: 10.1016/j.gofs.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/09/2024] [Indexed: 02/21/2024]
Abstract
Maternal deaths from indirect obstetric cause result from a preexisting condition or a condition that occurred during pregnancy without obstetric causes but was aggravated by the physiological effects of pregnancy. Twenty-nine deaths with an indirect cause related to a preexisting condition, excluding circulatory diseases or infections, were analysed by the expert committee. Pre-pregnancy pathology was documented in 16 women (epilepsy, n=7; amyloid angiopathy, n=1; Dandy-Walker syndrome, n=1; autoimmune diseases, n=3; diffuse infiltrative pneumonitis, n=1; thrombotic thrombocytopenic purpura, n=1; ovarian cancer in fragile X, n=1; major sickle cell disease, n=1). In 13 women, the pathology was unknown before pregnancy (breast cancer, n=9, epilepsy diagnosed during pregnancy, n=1, brain tumours, n=2 meningioma type, macrophagic activation syndrome, n=1). Death was associated with neoplastic or tumour pathology in 13 women (45%). At the same time, epilepsy was responsible for the death of 8 women (27%), making it the most common cause of death. For both neoplasia and epilepsy, about 50% of deaths were preventable, mainly due to undiagnosed and/or delayed treatment in the case of cancer and failure to monitor or adjust treatment in the case of epilepsy. Pre-conception counselling is therefore strongly recommended if a woman has a known chronic medical condition prior to pregnancy. Finally, if there is a family history of breast cancer, a breast examination is strongly recommended from the first visit during pregnancy, and any breast lumps should be investigated as soon as possible to avoid delaying appropriate treatment.
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Affiliation(s)
- Véronique Le Guern
- Médecine interne, centre de référence pour les maladies auto-immunes et systémiques rares d'Île de France, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Mathias Rossignol
- Département d'anesthésie-réanimation, SMUR, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75465 Paris, France
| | - Jacques Lepercq
- Service de gynécologie obstétrique, maternité Port Royal, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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Zhou SM, McLean B, Roberts E, Baines R, Hannon P, Ashby S, Newman C, Sen A, Wilkinson E, Laugharne R, Shankar R. Analysing patient-generated data to understand behaviours and characteristics of women with epilepsy of childbearing years: A prospective cohort study. Seizure 2023; 108:24-32. [PMID: 37060628 DOI: 10.1016/j.seizure.2023.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/02/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Women with epilepsy (WWE) are vulnerable in pregnancy, with increased risks to mother and baby including teratogenic risks, especially from valproate. The free EpSMon mobile-phone app allows self-monitoring to afford patient-centred feedback on seizure related risks, such as sudden death in epilepsy (SUDEP) to its users. We sought to generate insights into various seizure related risks and its treatments in WWE of childbearing age (16 to 60 years ) using EpSMon. METHODS The study utilizes a prospective real-world cohort of 5.5 years. Patient reported data on demographics, medication taken, diagnoses, seizure types and recognised biological, psychological, and social factors of seizure related harm were extracted. Data was stratified according to frequent and infrequent users and those scoring lower and higher risk scores. Multivariate logistic regression and different statistical tests were conducted. FINDINGS Data from 2158 WWE of childbearing age encompassing 4016 self-assessments were analysed. Overall risk awareness was 25.3% for pregnancy and 54.1% for SUDEP. Frequent users were more aware of pregnancy risks but not of SUDEP. Repeated EpSMon use increased SUDEP awareness but not pregnancy risks. Valproate was used by 11% of WWE, ranging from 6.5% of younger to 31.5% of older women. CONCLUSIONS The awareness to risks to pregnancy, SUDEP and valproate is low. Valproate is being used by a significant minority. It is imperative risk communication continues for WWE based on their individual situation and need. This is unlikely to be delivered by current clinical models. Digital solutions hold promise but require work done to raise implementation and acceptability.
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Affiliation(s)
- Shang-Ming Zhou
- Centre for Health Technology, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Brendan McLean
- Cornwall Intellectual Disability Equitable Research (CIDER), Peninsula School of Medicine, University of Plymouth, Truro, TR4 9LD, UK; Royal Cornwall Hospital NHS Trust, Truro TR1 3LJ, UK
| | - Elis Roberts
- School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth PL4 8AA, UK
| | - Rebecca Baines
- Cornwall Intellectual Disability Equitable Research (CIDER), Peninsula School of Medicine, University of Plymouth, Truro, TR4 9LD, UK
| | | | | | | | - Arjune Sen
- Nuffield Department of Clinical Neurosciences, University of Oxford, OX39DU, UK
| | | | - Richard Laugharne
- Cornwall Intellectual Disability Equitable Research (CIDER), Peninsula School of Medicine, University of Plymouth, Truro, TR4 9LD, UK; Psychoanalytica St Germans, UK; Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust Truro TR4 9LD UK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), Peninsula School of Medicine, University of Plymouth, Truro, TR4 9LD, UK; Psychoanalytica St Germans, UK; Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust Truro TR4 9LD UK.
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3
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Xu ZYR, Qian P, Cai MT, Ding MP, Guo Y. Management of epilepsy in pregnancy in eastern China: A survey from the Zhejiang association against epilepsy. Front Neurol 2022; 13:1001918. [PMID: 36468050 PMCID: PMC9714667 DOI: 10.3389/fneur.2022.1001918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/01/2022] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the knowledge of the board members of the Zhejiang Association Against Epilepsy (ZAAE) regarding pregnancy of women with epilepsy (WWE), as well as their clinical practice and obstacles in the management of WWE. METHODS A cross-sectional survey was conducted among the board members of the ZAAE using a questionnaire based on the management guidelines for WWE during pregnancy in China. We recorded the demographic characteristics of the surveyed practitioners, the coincidence rate of each question, clinical practice, and the barriers encountered in managing WWE. RESULTS This survey showed that the average knowledge score of the surveyed practitioners was 71.02%, and the knowledge score of neurologists was higher than that of neurosurgeons. Knowledge regarding the following three aspects was relatively poor: whether WWE is associated with an increased risk of cesarean section and preterm delivery, the preferred analgesic drugs for WWE during delivery, and the time of postpartum blood concentration monitoring. After multiple linear regression analysis, the score of neurologists was correlated to the number of pregnant WWE treated each year. In addition, the biggest difficulty in the management of WWE during pregnancy is the lack of patient education and doctors training on pregnant epilepsy management. CONCLUSION Our study revealed the ZAAE board members' knowledge and management status of pregnant WWE. In addition, our study identified the biggest obstacle to the management of WWE during pregnancy, and emphasized the importance of training and practice of epilepsy knowledge during pregnancy for practitioners and the significance of interdisciplinary communication.
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Affiliation(s)
- Zheng-Yan-Ran Xu
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ping Qian
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Meng-Ting Cai
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Mei-ping Ding
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Guo
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Department of General Practice and International Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
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Simeone RM, Reefhuis J, Jamieson DJ, Drews-Botsch CD, Lash TL, Fisher SC, Howley MM, Evans S, Howards PP. Delayed entry into prenatal care among women with pre-pregnancy health conditions, National Birth Defects Prevention Study, 1997-2011. Prev Med 2022; 164:107272. [PMID: 36152821 PMCID: PMC10392703 DOI: 10.1016/j.ypmed.2022.107272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 09/18/2022] [Indexed: 10/31/2022]
Abstract
First trimester entry into prenatal care is recommended for all women, and especially women with pre-pregnancy conditions. Our objective was to determine whether women with pre-pregnancy conditions were at lower risk of entry after the first trimester (delayed entry) into prenatal care than women without a pre-pregnancy health condition. We used data from 10,890 participants in the National Birth Defects Prevention Study who delivered liveborn infants without birth defects. Women reported pre-pregnancy conditions and timing of entry into prenatal care during a computer-assisted telephone interview. Multivariable logistic regression analyses were conducted to evaluate whether having a pre-pregnancy condition was associated with delayed entry into prenatal care compared to women without pre-pregnancy conditions. Approximately 13% of women reported delayed entry into prenatal care, and 18% of women reported a pre-pregnancy condition. Delayed entry into prenatal care was not associated with pre-pregnancy cardiometabolic or neurologic conditions. Women with thyroid conditions were less likely to report delayed entry into prenatal care (prevalence odds ratio (OR), 95% confidence interval (CI): 0.55 [0.32, 0.94]), but women with hematologic and respiratory conditions were more likely to report delayed entry into prenatal care (OR: 1.95 [1.00, 3.82] and 1.27 [0.95, 1.72], respectively), compared to those without any chronic conditions. Future research investigating the success of early prenatal care among women with thyroid conditions could identify ways to reduce delayed prenatal care among women with other pre-pregnancy conditions.
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Affiliation(s)
- Regina M Simeone
- Centers for Disease Control and Prevention, Atlanta, GA, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - Jennita Reefhuis
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Carolyn D Drews-Botsch
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Sarah C Fisher
- Birth Defects Registry, New York State Department of Health, Albany, NY, United States
| | - Meredith M Howley
- Birth Defects Registry, New York State Department of Health, Albany, NY, United States
| | - Shannon Evans
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Guarracino I, Ius T, Pauletto G, Maieron M, D’Agostini S, Skrap M, Tomasino B. Incidental low grade glioma in young female: an indolent lesion? A case report and a literature review. Clin Neurol Neurosurg 2022; 223:107520. [DOI: 10.1016/j.clineuro.2022.107520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022]
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6
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Podgorac J, Sekulić S, Petković B, Stojadinović G, Martać L, Pešić V. The influence of continuous prenatal exposure to valproic acid on physical, nociceptive, emotional and psychomotor responses during adolescence in mice: Dose-related effects within sexes. Front Behav Neurosci 2022; 16:982811. [PMID: 36248030 PMCID: PMC9557044 DOI: 10.3389/fnbeh.2022.982811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/31/2022] [Indexed: 11/23/2022] Open
Abstract
Clinical findings show that the use of valproic acid (VPA) during pregnancy increases the risk of birth defects and autism spectrum disorder in offspring. Although there is a consensus that monitoring of potential long-term outcomes of VPA exposure is needed, especially in undiagnosed individuals, preclinical studies addressing this issue are rare. The present study examined the effects of continuous intrauterine exposure to a wide dose range of VPA (50, 100, 200, and 400 mg/kg/day) on the physical and behavioral response in peripubertal mice as a rodent model of adolescence. Body weight and the hot plate test [on postnatal days (PND) 25 and 32], the elevated plus-maze test (on PND35), and the open field test (on PND40) served to examine physical growth, the supraspinal reflex response to a painful thermal stimulus and conditional learning, anxiety-like/risk-assessment behavior, as well as novelty-induced psychomotor activity, respectively. VPA exposure produced the following responses: (i) a negative effect on body weight, except for the dose of 100 mg/kg/day in both sexes; (ii) an increase in the percentage of animals that responded to the thermal stimulus above the defined cut-off time interval and the response latency in both sexes; (iii) dose-specific changes within sexes in behavior provoked by a novel anxiogenic environment, i.e., in females less anxiety-like/risk-assessment behavior in response to the lowest exposure dose, and in males more pronounced anxiety-like/risk-assessment behavior after exposure to the highest dose and 100 mg/kg/day; (iv) dose-specific changes within sexes in novelty-induced psychomotor activity, i.e., in females a decrease in stereotypy-like activity along with an increase in rearing, and in males a decrease in stereotypy-like activity only. These findings show that continuous intrauterine exposure to VPA produces maladaptive functioning in different behavioral domains in adolescence and that the consequences are delicate to assess as they are dose-related within sexes.
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Affiliation(s)
- Jelena Podgorac
- Department of Neurophysiology, Institute for Biological Research “Siniša Stanković” – National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Slobodan Sekulić
- Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Branka Petković
- Department of Neurophysiology, Institute for Biological Research “Siniša Stanković” – National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Gordana Stojadinović
- Department of Neurophysiology, Institute for Biological Research “Siniša Stanković” – National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Ljiljana Martać
- Department of Neurophysiology, Institute for Biological Research “Siniša Stanković” – National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Vesna Pešić
- Department of Neurobiology, Institute for Biological Research “Siniša Stanković” – National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
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7
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Logue TC, Huang Y, Benson RJ, Pack AM, Wright JD, D’Alton ME, Friedman AM. Use of antiepileptic drugs by trimester. J Matern Fetal Neonatal Med 2022; 35:10158-10161. [DOI: 10.1080/14767058.2022.2122039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Teresa C. Logue
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachael J. Benson
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Alison M. Pack
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jason D. Wright
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Mary E. D’Alton
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander M. Friedman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Columbia University Irving Medical Center, New York, NY, USA
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8
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Placental Models for Evaluation of Nanocarriers as Drug Delivery Systems for Pregnancy Associated Disorders. Biomedicines 2022; 10:biomedicines10050936. [PMID: 35625672 PMCID: PMC9138319 DOI: 10.3390/biomedicines10050936] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/06/2022] [Accepted: 04/18/2022] [Indexed: 12/12/2022] Open
Abstract
Pregnancy-associated disorders affect around 20% of pregnancies each year around the world. The risk associated with pregnancy therapeutic management categorizes pregnant women as “drug orphan” patients. In the last few decades, nanocarriers have demonstrated relevant properties for controlled drug delivery, which have been studied for pregnancy-associated disorders. To develop new drug dosage forms it is mandatory to have access to the right evaluation models to ensure their usage safety and efficacy. This review exposes the various placental-based models suitable for nanocarrier evaluation for pregnancy-associated therapies. We first review the current knowledge about nanocarriers as drug delivery systems and how placenta can be used as an evaluation model. Models are divided into three categories: in vivo, in vitro, and ex vivo placental models. We then examine the recent studies using those models to evaluate nanocarriers behavior towards the placental barrier and which information can be gathered from these results. Finally, we propose a flow chart on the usage and the combination of models regarding the nanocarriers and nanoparticles studied and the intended therapeutic strategy.
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Durai V, Sagili H, Durairaj J, Ananthakrishnan R, Nair PP, Keepanasseril A, Keepanasseril A. Managing pregnancy in women with Sturge-Weber syndrome: case report and review of the literature. J OBSTET GYNAECOL 2022; 42:751-756. [PMID: 35164628 DOI: 10.1080/01443615.2022.2027895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Sturge-Weber syndrome (SWS) is a sporadic congenital neuro-cutaneous anomaly with capillary-venous malformation involving the brain, eye, and the ophthalmic division of the trigeminal nerve. In these cases, physiological changes in pregnancy, including hormonal and hemodynamic changes, may predispose to increased seizure frequency and even a life-threatening intracranial haemorrhage. There are only few case reports available about the management of women with pregnancy and SWS. We report two patients with SWS diagnosed in childhood and managed during pregnancy and reviewed the outcomes and complications during pregnancy in women with this disorder.
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Affiliation(s)
- Vignesh Durai
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Haritha Sagili
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Jayalakshmi Durairaj
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Ramesh Ananthakrishnan
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Pradeep P Nair
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Arun Keepanasseril
- Amrita Institute of Medical Sciences, Kochi, India.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Anish Keepanasseril
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
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Twenty-year trends in the use of anti-seizure medication among pregnant women in the Netherlands. Epilepsy Behav 2022; 127:108549. [PMID: 35042161 DOI: 10.1016/j.yebeh.2021.108549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Anti-seizure medications (ASMs) are used to treat conditions such as epilepsy and bipolar disorder. Some of these drugs are associated with an increased risk of congenital malformations and adverse developmental outcomes. OBJECTIVES To examine trends in use of ASMs among pregnant women in the Netherlands according to medication safety profile. METHODS Using population-based data from the PHARMO Perinatal Research Network, we assessed trends in use of ASMs among pregnant women in the Netherlands between 1999 and 2019, stratified by medication safety profile. Individual treatment patterns were also assessed. RESULTS In total, 671,709 pregnancies among 446,169 women were selected, of which 2405 (3.6 per 1000) were ASM-exposed. Over the study period, a significant increase was observed for use of known safest ASMs (0.7-18.0 per 10,000 pregnancies) as well as for those with uncertain risk (5.3-13.4 per 10,000 pregnancies). Use of ASMs with higher risk of congenital malformations decreased significantly (24.8-14.5 per 10,000 pregnancies), except for topiramate (0-6.7 per 10,000 pregnancies). Switches between ASM safety risk categories before and during pregnancy were uncommon; women rather discontinued treatment or switched within the same category. There was no clear change for the proportion using polytherapy during pregnancy (12% overall), however a non-significant trend toward inclusion of known safest ASMs was observed over time (1.9-3.6%). CONCLUSIONS Over the last two decades, there has been an increase in use of known safest ASMs among pregnant women, together with a trend toward newer ASMs with uncertain risk. Only a small proportion of women switched to a safer alternative before or during pregnancy. Altogether, this highlights the need for an expansion of ASM risk knowledge and communication to healthcare providers and women of reproductive age to improve preconception counseling.
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Epilepsy in Pregnancy—Management Principles and Focus on Valproate. Int J Mol Sci 2022; 23:ijms23031369. [PMID: 35163292 PMCID: PMC8836209 DOI: 10.3390/ijms23031369] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 02/06/2023] Open
Abstract
An estimated 60 million people worldwide suffer from epilepsy, half of whom are women. About one-third of women with epilepsy are of childbearing age. The childbirth rate in women with epilepsy is about 20–40% lower compared to that of the general population, which may be partly due to a lower number of these women being in relationships. Lower fertility in women with epilepsy may be linked to the disease itself, but it is mainly a result of the treatment provided. Valproate, as an antiepileptic drug inhibiting histone deacetylases, may affect the expression of genes associated with cell cycle control and cellular differentiation. Evidently, this drug is associated with the risk of malformations although other antiepileptic drugs (AEDs) may also trigger birth defects, however, to a lower degree. Valproate (and to a certain degree other AEDs) may induce autism spectrum disorders and attention deficit hyperactivity disorder. The main mechanism responsible for all negative effects of prenatal exposure to valproate seems inhibition of histone deacetylases. Animal studies show a reduction in the expression of genes involved in social behavior and an increase in hippocampal cytokines. Valproate-induced oxidative stress may also contribute to neural tube defects. Interestingly, paternal exposure to this AED in mice may trigger neurodevelopmental disorders as well although a population-based cohort study does not confirm this effect. To lower the risk of congenital malformations and neurodevelopmental disorders, a single AED at the optimal dose and supplementation with folic acid is recommended. VPA should be avoided in women of childbearing age and especially during pregnancy.
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Lai W, He S, Zhou D, Chen L. Managing reproductive problems in women with epilepsy of childbearing age. ACTA EPILEPTOLOGICA 2021. [DOI: 10.1186/s42494-021-00062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractGirls and women constitute nearly 50% of all epilepsy cases. Apart from the disease symptoms, epilepsy and antiseizure medications (ASMs) may also affect the reproductive function, pregnancy and even the health of their offspring. Therefore, it is very important to identify and summarize the problems and risks for women with epilepsy (WWE) of childbearing age, and offer internationally recognized methods through multidisciplinary collaboration. In this review, we summarize the reproduction-related problems with WWE and propose multidisciplinary management by epileptologists, gynecologists and obstetricians, as well as other experts, from preconception to delivery. Large, multicenter registries are needed to advance our knowledge on new ASMs and their effects on WWE and their offspring.
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Levetiracetam, lamotrigine and carbamazepine: which monotherapy during pregnancy? Neurol Sci 2021; 43:1993-2001. [PMID: 34468899 PMCID: PMC8860795 DOI: 10.1007/s10072-021-05542-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/31/2021] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Epilepsy treatment during pregnancy is still challenging. The study is aimed at comparing the efficacy and safety of carbamazepine (CBZ), lamotrigine (LTG) and levetiracetam (LEV) monotherapies during pregnancy in women with focal (FE) or generalized (GE) epilepsy. METHODS A multicentre retrospective study was conducted to evaluate seizures frequency and seizure freedom (SF) rate during 3 months before pregnancy, each trimester of gestation and post-partum period in women on monotherapy with CBZ, LTG and LEV. RESULTS Fifty-seven pregnancies (45 FE, 12 GE) on monotherapy (29 CBZ, 11 LTG, 17 LEV) were included. A significant reduction of seizure frequency was found in the first trimester of pregnancy as compared with that one before pregnancy (p = 0.004), more evident in GE (p = 0.003) and in LEV group (p = 0.004). The SF rate significantly increased in the first trimester in comparison to that one before pregnancy and persisted in the post-partum period in the whole sample (p < 0.001) and in women on LEV (p = 0.004). Besides, 88.57% of SF women before pregnancy remained unchanged during gestation and the post-partum period. One major heart malformation in CBZ and no major malformations in LTG and LEV groups were found. CONCLUSIONS A better clinical outcome during pregnancy emerged since the first trimester in comparison to the before-pregnancy period, mostly evident in women with GE and LEV therapy, reinforcing the hypothesis of a protective role of pregnancy versus seizures. SF before pregnancy represents a significant predictive factor of good clinical outcome during gestation and the post-partum period. Compared to CBZ, LTG and LEV showed a better safety profile.
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14
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Kameg BN. Bipolar disorder: Treatment strategies for women of childbearing age. Perspect Psychiatr Care 2021; 57:1244-1249. [PMID: 33164215 DOI: 10.1111/ppc.12680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/16/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Bipolar disorder is associated with increased rates of morbidity and mortality, magnified in women of childbearing age. The purpose of this paper is to provide an overview of the differential diagnosis and management of bipolar disorder in women of childbearing age. CONCLUSIONS Differential diagnoses for bipolar disorder include depressive disorders, anxiety disorders, trauma-related disorders, attention-deficit/hyperactivity disorder, and personality disorders. Pharmacotherapeutic options for the treatment of bipolar disorder include lithium, anti-epileptic medications, and atypical antipsychotics. In regard to women of childbearing age, consideration of risks, benefits, and alternative therapies is needed before initiating therapy. PRACTICE IMPLICATIONS Caring for patients with bipolar disorder, particularly women of childbearing age, requires careful differentiation of bipolar disorder from other mental health problems, and prudent consideration of pharmacotherapeutic options.
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Affiliation(s)
- Brayden N Kameg
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
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Aykan DA, Ergün Y. Cross-sectional evaluation of prescription of valproate and other antiepileptic drugs to pregnant women. Acta Neurol Belg 2021; 121:503-508. [PMID: 31659713 DOI: 10.1007/s13760-019-01231-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/20/2019] [Indexed: 10/25/2022]
Abstract
Drug counseling is important in women with epilepsy since data about the effects of maternal antiepileptics on the developing fetus are limited. Although pregnant patients on the most teratogenic drugs are treated in accordance to the European Medicines Agency guidelines, a large amount of them may be exposed to the teratogenic medications unintentionally. We performed a tertiary center observational study about medications of pregnant women who were consulted to Teratology Information Service (TIS) unit for evidence-based teratogenic risk analysis. The registration records of 134 pregnant women between 2014 and 2018 were examined. We evaluated the diagnoses, prescriptions, usage of antiepileptic drugs, and distribution of drug subtypes and investigated the drug-related congenital anomalies after delivery. Women were recontacted after delivery to obtain information about health status of infants. We found that 33 women were diagnosed with neurological disorders. A total number of 60 neurologic drugs was prescribed, including 13 antiepileptics. Antiepileptic drugs covered 38.4% valproate (n = 5), 15.4% pregabalin/gabapentin (n = 2), 15.4% levetiracetam (n = 2), 15.4% lamotrigine (n = 2), 7.7% phenytoin (n = 1), and 7.7% carbamazepine (n = 1). Delivery outcomes revealed that valproate exposure resulted in one baby with congenital cataracts, one postnatal exitus with cardiac dysfunction, and one therapeutic abortion. Various antiepileptic drugs were prescribed to pregnant women prenatally or at different times of pregnancy and valproate was the most common antiepileptic drug consulted to TIS for teratogenic risk analysis. Disseminating TIS units and reporting the outcomes to the teratogenesis literature provide proper evaluation of teratogenic risks of drugs accordingly.
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Patel T, Grindrod KA. Antiseizure drugs and women: Challenges with contraception and pregnancy. Can Pharm J (Ott) 2020; 153:357-360. [PMID: 33282026 PMCID: PMC7689629 DOI: 10.1177/1715163520959735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tejal Patel
- School of Pharmacy, University of Waterloo, Kitchener, Ontario
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Patel T, Grindrod K. Antiseizure drugs for women with epilepsy: Before, during, and after pregnancy. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:266-269. [PMID: 32273414 PMCID: PMC7145120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Tejal Patel
- Pharmacist and Assistant Clinical Professor, University of Waterloo School of Pharmacy in Ontario
| | - Kelly Grindrod
- Pharmacist and Associate Professor, University of Waterloo School of Pharmacy in Ontario
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TANTİK PAK AYGÜL. GEBELERDE EPİLEPSİ TEDAVİSİ. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2020. [DOI: 10.33631/duzcesbed.627171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ishikawa T, Obara T, Jin K, Nishigori H, Miyakoda K, Suzuka M, Ikeda-Sakai Y, Akazawa M, Nakasato N, Yaegashi N, Kuriyama S, Mano N. Examination of the prescription of antiepileptic drugs to prenatal and postpartum women in Japan from a health administrative database. Pharmacoepidemiol Drug Saf 2019; 28:804-811. [DOI: 10.1002/pds.4749] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/18/2018] [Accepted: 01/19/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Tomofumi Ishikawa
- Laboratory of Clinical Pharmacy, Graduate School of Pharmaceutical Sciences; Tohoku University; Sendai Japan
| | - Taku Obara
- Department of Pharmaceutical Sciences; Tohoku University Hospital; Sendai Japan
- Environment and Genome Research Center, Graduate School of Medicine; Tohoku University; Sendai Japan
- Tohoku Medical Megabank Organization; Tohoku University; Sendai Japan
| | - Kazutaka Jin
- Department of Epileptology, Graduate School of Medicine; Tohoku University; Sendai Japan
| | - Hidekazu Nishigori
- Environment and Genome Research Center, Graduate School of Medicine; Tohoku University; Sendai Japan
- Department of Gynecology and Obstetrics, Graduate School of Medicine; Tohoku University; Sendai Japan
| | - Keiko Miyakoda
- Tohoku Medical Megabank Organization; Tohoku University; Sendai Japan
| | - Masato Suzuka
- Department of Pharmaceutical Sciences; Tohoku University Hospital; Sendai Japan
| | - Yasuko Ikeda-Sakai
- Department of Health Informatics, Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Manabu Akazawa
- Department of Public Health and Epidemiology; Meiji Pharmaceutical University; Tokyo Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Graduate School of Medicine; Tohoku University; Sendai Japan
| | - Nobuo Yaegashi
- Environment and Genome Research Center, Graduate School of Medicine; Tohoku University; Sendai Japan
- Tohoku Medical Megabank Organization; Tohoku University; Sendai Japan
- Department of Epileptology, Graduate School of Medicine; Tohoku University; Sendai Japan
| | - Shinichi Kuriyama
- Environment and Genome Research Center, Graduate School of Medicine; Tohoku University; Sendai Japan
- Tohoku Medical Megabank Organization; Tohoku University; Sendai Japan
- International Research Institute for Disaster Science; Tohoku University; Sendai Japan
| | - Nariyasu Mano
- Laboratory of Clinical Pharmacy, Graduate School of Pharmaceutical Sciences; Tohoku University; Sendai Japan
- Department of Pharmaceutical Sciences; Tohoku University Hospital; Sendai Japan
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Wilson RD. Prévention = conseil préconceptionnel. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1272-1276. [DOI: 10.1016/j.jogc.2018.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wilson RD. Prevention = Pre-Conception Counselling. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1267-1271. [DOI: 10.1016/j.jogc.2018.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 05/14/2018] [Indexed: 12/01/2022]
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Affiliation(s)
- Kim Morley
- Independent and supplementary prescriber, and MSc Candidate, Maternity and Neurology Services, Hampshire Hospitals Foundation Trust
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Shahla M, Hijran B, Sharif M. The course of epilepsy and seizure control in pregnant women. Acta Neurol Belg 2018; 118:459-464. [PMID: 29981006 DOI: 10.1007/s13760-018-0974-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
To investigate the course of epilepsy and seizure control during pregnancy. 105 pregnant women with epilepsy were studied prospectively during the period from 2013 to 2017. The average age at the onset of epilepsy was 17.4 ± 0.5 years. Seizures during pregnancy were observed in 76 (72.4 ± 4.4%) women. Eleven (10.5 ± 3.0%) women had their first seizure during current pregnancy. Among those 94 women who were diagnosed with epilepsy before pregnancy, 29 (30.9 ± 4.8%) remained seizure free; seizure frequency increased in 27 (28.7 ± 4.7%), decreased in 24 (25.5 ± 4.5%) women, in 14 (14.9 ± 3.7%) remained unchanged. Among 15 women who were seizure free for the 1 year prior to pregnancy 11 (73.3 ± 11.4%) women remained seizure free during pregnancy. The worsening in seizure control during pregnancy occurred in 22 (35.5 ± 6.1%) of 62 women with focal epilepsy and 5 (15.6 ± 6.4%) of 32 with idiopathic generalized epilepsy (OR 2.97, 95% CI 1.0-8.81). Non-compliance with the antiepileptic drug therapy was observed in 20 (19.0 ± 3.8%) pregnant women, seizure frequency increased in 18 (90.0 ± 6.7%) of them compared with 5 (9.8 ± 4.2%) of 51 of those who followed correct antiepileptic drug regimen (p < 0.001). The risk of seizures during pregnancy was lower in women who were seizure-free for the 1 year prior to pregnancy; focal epilepsy was associated with an increased risk of seizure relapse during pregnancy; non-compliance with the antiepileptic drug therapy and inappropriate treatment may lead to worsening of seizure control and to the status epilepticus during pregnancy.
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Dijkman SC, Wicha SG, Danhof M, Della Pasqua OE. Individualized Dosing Algorithms and Therapeutic Monitoring for Antiepileptic Drugs. Clin Pharmacol Ther 2017; 103:663-673. [DOI: 10.1002/cpt.777] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 05/24/2017] [Accepted: 06/20/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Sven C. Dijkman
- Division of PharmacologyLeiden Academic Centre for Drug ResearchLeiden The Netherlands
| | - Sebastian G. Wicha
- Department of Pharmaceutical BiosciencesUppsala UniversityUppsala Sweden
| | - Meindert Danhof
- Division of PharmacologyLeiden Academic Centre for Drug ResearchLeiden The Netherlands
| | - Oscar E. Della Pasqua
- Clinical Pharmacology Modelling & SimulationGlaxoSmithKlineUxbridge UK
- Clinical Pharmacology and TherapeuticsUniversity College LondonLondon UK
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Jazebi N, Moghimi N, Lall R, Osadebey E, Ortega-Barnett J, Masel T. Successful implantation and immediate activation of Vagus Nerve Stimulation (VNS) during pregnancy in a patient with intractable epilepsy: A case illustration and review of the literature. J Clin Neurosci 2017; 42:114-115. [DOI: 10.1016/j.jocn.2017.03.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 03/13/2017] [Indexed: 01/31/2023]
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