TOPLINE:
Maternal usage of antiseizure medications (ASMs) throughout pregnancy does not increase epilepsy danger in offspring beyond the danger related to maternal epilepsy itself, a brand-new research study programs.
APPROACH:
- This potential, population-based register mate research study consisted of 38,663 singleton children (51.4% male) born to moms with epilepsy in Denmark, Finland, Iceland, Norway, and Sweden in between January 1, 1996, and December 31, 2017.
- Detectives tracked redeemed prescriptions for an ASM (eg, valproate, lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, and clonazepam) from 30 days prior to pregnancy till birth.
- The primary result was epilepsy in offspring, while secondary analyses consisted of dose-response analyses, analyses of moms who stopped ASM prior to pregnancy (referral), and sibling analyses.
- Kids were followed from birth, with a mean follow-up of 7 years.
TAKEAWAY:
- Compared to no ASM direct exposure throughout pregnancy, there was considerably greater threat for epilepsy amongst offspring with prenatal direct exposure to valproate monotherapy (adjusted danger ratio [aHR]2.18; 95% CI, 1.70-2.79) or polytherapy (aHR, 2.10; 95% CI, 1.49-2.96), topiramate monotherapy (aHR, 2.34; 95% CI, 1.30-4.16), clonazepam monotherapy (aHR, 1.90; 95% CI, 1.16-3.12), and polytherapy without valproate (aHR, 1.39; 95% CI, 1.04-1.84).
- The association in between offspring epilepsy threat and prenatal valproate usage was not dose-dependent, and there was no distinction in danger in between offspring with or without prenatal direct exposure to topiramate.
- Analysis of a subset of 258 moms who utilized valproate in a minimum of one pregnancy and no ASM in a minimum of another pregnancy exposed no considerable distinction in epilepsy threat in between brother or sisters.
- No associations were discovered for prenatal direct exposure to lamotrigine, levetiracetam, carbamazepine, or oxcarbazepine.
IN PRACTICE:
Kids of moms who utilized valproate or topiramate throughout pregnancy were more most likely to establish epilepsy than kids whose moms utilized no ASM in pregnancy, level of sensitivity analyses recommended that the associations were most likely described by distinctions in other aspects, the authors composed. “These analyses recommend that the increased threat of epilepsy discovered in kids with prenatal valproate direct exposure was most likely puzzled by underlying elements related to both maternal valproate usage and the kid’s threat of epilepsy (eg, the kind of maternal epilepsy).”
SOURCE:
Julie Werenberg Dreier, PhD, senior scientist, Aarhus University, Aarhus, Denmark, was the lead and matching author on the research study. The research study was released online on February 26 in JAMA Network Open
RESTRICTIONS:
The scientists count on register-based recognition of epilepsy in kids and their moms, and some misclassification of their epilepsy status was possible. Category of the subtype of maternal epilepsy (a secret confounder in this research study) was “difficult” due to the low credibility of ICD-10 codes for epilepsy subclassification. Utilizing maternal prescription fills as a proxy for prenatal ASM direct exposure may have likewise resulted in some misclassification.
DISCLOSURES:
This research study was supported by grants from the NordForsk Nordic program on health, the Independent Research Fund Denmark, IMI Conception, the Danish Epilepsy Association,
