Midtveisevaluering - Kim Christian Danielsson

Kim Christian Danielsson er ph.d. kandidat ved Klinisk Institutt 1.
Veiledere er Nils Erik Gilhus, Ingrid Borthen og Nils-Halvdan Morken.

Epilepsy and pregnancy: Risk factors for maternal complications in women with epilepsy and antiepileptic drugs

Epilepsy is the most common chronic neurological disease in pregnancy and almost half of all women with epilepsy (WWE) use antiepileptic drugs (AEDs) in pregnancy. Women with epilepsy are considered as high risk parturients with increased risk of pregnancy and obstetric complications. Epileptic activity and seizures in pregnancy should be avoided but AED use in pregnancy is balanced against possible adverse fetal effects. The AEDs used in pregnancy have changed since 1990s towards newer drugs with less adverse fetal effects. This paradigm shift has not taken into account considerations of possible obstetric and pregnancy complications.

In this project, we study the cause and risk factors for obstetric and pregnancy complications in WWE. We want to explore the effect of AEDs on complications in WWE. Since pregnancy complications may also be due to epilepsy pathophysiology, socio-demographic variables or other concurrent medical conditions, we want to investigate which risk factors predict maternal morbidity in WWE. We have used linked data from Medical Birth Registry of Norway, Norwegian Prescription Database, and Statistics Norway to assess hypertensive disorders of pregnancy in among first pregnancies of WWE compared to women without epilepsy. We have also assessed the effect of parity on changes in risk for complications.

Our findings suggest that WWE only have increased risk of mild preeclampsia, but not the severe types of hypertensive pregnancy complications. The newer AEDs do not predispose to hypertensive disorders, whereas valproate increases the risk of mild preeclampsia. When first and second pregnancies were compared we found a significant reduction in risk of pregnancy and obstetric complications from first to second pregnancies for WWE with an additional epilepsy-specific reduction in risk compared to women without epilepsy. Second pregnancies in WWE only have increased risk of iatrogenic complications, induction of labour and cesarean section. We also found that body mass index, other chronic diseases, and smoking affect some of the risk estimates for complications in WWE.