ImportanceMaternal epilepsy is associated with adverse pregnancy and neonatal outcomes. A better understanding of this condition and the associated risk of mortality and morbidity at the time of delivery could help reduce adverse outcomes.ObjectiveTo determine the risk of severe maternal and perinatal morbidity and mortality among women with epilepsy.Design, Setting, ParticipantsThis prospective population-based register study in Denmark, Finland, Iceland, Norway, and Sweden took place between January 1, 1996, and December 31, 2017. Data analysis was performed from August 2022 to November 2023. Participants included all singleton births at 22 weeks’ gestation or longer. Births with missing or invalid information on birth weight or gestational length were excluded. The study team identified 4 511 267 deliveries, of which 4 475 984 were to women without epilepsy and 35 283 to mothers with epilepsy.ExposureMaternal epilepsy diagnosis recorded before childbirth. Prenatal exposure to antiseizure medication (ASM), defined as any maternal prescription fills from conception to childbirth, was also examined.Main outcomes and measuresComposite severe maternal morbidity and mortality occurring in pregnancy or within 42 days postpartum and composite severe neonatal morbidity (eg, neonatal convulsions) and perinatal mortality (ie, stillbirths and deaths) during the first 28 days of life. Multivariable generalized estimating equations with logit-link were used to obtain adjusted odds ratios (aORs) and 95% CIs.ResultsThe mean (SD) age at delivery for women in the epilepsy cohort was 29.9 (5.3) years. The rate of composite severe maternal morbidity and mortality was also higher in women with epilepsy compared with those without epilepsy (36.9 vs 25.4 per 1000 deliveries). Women with epilepsy also had a significantly higher risk of death (0.23 deaths per 1000 deliveries) compared with women without epilepsy (0.05 deaths per 1000 deliveries) with an aOR of 3.86 (95% CI, 1.48-8.10). In particular, maternal epilepsy was associated with increased odds of severe preeclampsia, embolism, disseminated intravascular coagulation or shock, cerebrovascular events, and severe mental health conditions. Fetuses and infants of women with epilepsy were at elevated odds of mortality (aOR, 1.20; 95% CI, 1.05-1.38) and severe neonatal morbidity (aOR, 1.48; 95% CI, 1.40-1.56). In analyses restricted to women with epilepsy, women exposed to ASM compared with those unexposed had higher odds of severe maternal morbidity (aOR ,1.24; 95% CI, 1.10-1.48) and their neonates had an increased odd of mortality and severe morbidity (aOR, 1.37; 95% CI, 1.23-1.52).Conclusion and relevanceThis multinational study shows that women with epilepsy were at considerably higher risk of severe maternal and perinatal outcomes and increased risk of death during pregnancy and postpartum. Maternal epilepsy and maternal use of ASM were associated with increased maternal morbidity and perinatal mortality and morbidity.

中文翻译：

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癫痫孕妇围产期和产妇发病和死亡的风险


重要性孕产妇癫痫与不良妊娠和新生儿结局相关。更好地了解这种情况以及分娩时死亡和发病的相关风险有助于减少不良后果。目的确定癫痫妇女中严重孕产妇和围产期发病和死亡的风险。设计、背景、参与者这一预期人群-这项基于丹麦、芬兰、冰岛、挪威和瑞典的登记研究于 1996 年 1 月 1 日至 2017 年 12 月 31 日期间进行。数据分析于 2022 年 8 月至 2023 年 11 月进行。参与者包括妊娠 22 周或更长。出生体重或孕周信息缺失或无效的出生被排除在外。研究小组确定了 4 511 267 次分娩，其中 4 475 984 次是没有癫痫的女性，35 283 次是患有癫痫的母亲。暴露记录了分娩前的母亲癫痫诊断。还检查了产前抗癫痫药物 (ASM) 暴露（定义为从受孕到分娩期间服用的任何孕产妇处方）。 主要结局和措施 怀孕期间或产后 42 天内发生的复合严重孕产妇发病率和死亡率以及复合严重新生儿发病率（例如，新生儿惊厥）和出生后 28 天内的围产期死亡率（即死产和死亡）。使用带有 logit-link 的多变量广义估计方程来获得调整后的比值比 (aOR) 和 95% CI。结果癫痫队列中女性的平均分娩年龄 (SD) 为 29.9 (5.3) 岁。与没有癫痫的女性相比，患有癫痫的女性的综合严重孕产妇发病率和死亡率也更高（每 1000 次分娩中 36.9 例 vs 25.4 例）。 与没有癫痫的女性（每 1000 次分娩 0.05 例死亡）相比，患有癫痫的女性的死亡风险也显着更高（每 1000 例分娩 0.23 例死亡），aOR 为 3.86（95% CI，1.48-8.10）。特别是，孕产妇癫痫与严重先兆子痫、栓塞、弥散性血管内凝血或休克、脑血管事件和严重精神健康状况的几率增加有关。癫痫妇女的胎儿和婴儿死亡率较高（aOR，1.20；95% CI，1.05-1.38），新生儿发病率较高（aOR，1.48；95% CI，1.40-1.56）。在仅限于癫痫女性的分析中，与未接触过 ASM 的女性相比，接触过 ASM 的女性发生严重孕产妇发病的几率更高（aOR ,1.24；95% CI, 1.10-1.48），而且她们的新生儿死亡率和严重发病率也更高（aOR ,1.24；95% CI, 1.10-1.48）。 ，1.37；95% CI，1.23-1.52）。结论和相关性这项多国研究表明，患有癫痫的女性发生严重孕产妇和围产期结局的风险相当高，并且怀孕期间和产后死亡的风险也增加。孕产妇癫痫和孕产妇使用 ASM 与孕产妇发病率和围产期死亡率和发病率增加有关。