(206) Use of Antiepileptic Drugs During Pregnancy and Neonatal Birth Weight Outcomes: A Systematic Review and Meta-Analysis

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 537

Presenting Author(s)

Alekhya Lavu
– The University of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada

Co-Author(s)

Christine Vaccaro, BSc
– College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada
Enav Zusman
– British Columbia Children’s Hospital Research Institute, Canada
Laila Nabil Mahmoud Helmy Aboulatta
– PhD student, University of Manitoba, Winnipeg, Manitoba, Canada
Basma Aloud
– University of Manitoba, MB, Canada
Rasheda Rabbani
– George & Fay Yee Center for Healthcare Innovation, Winnipeg, Manitoba, Canada, MB, Canada
Payam Peymani, PharmD
– Postdoctoral Fellow, The University of Manitoba, Winnipeg, Manitoba, Canada
Walid Shouman
– University of Manitoba, Winnipeg, MB, Canada
Silvia Alessi-Severini
– Professor, College of Pharmacy, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Canada., MB, Canada
Sherif Eltonsy, PhD
– Assistant Professor, University of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada

Background: Exposure to Antiepileptic drugs (AED) during pregnancy has been associated with various neonatal outcomes, including adverse birthweight outcomes.

Objectives: The study objective is to systematically synthesize the current published literature on neonatal growth outcomes.

Methods: Seven databases including MEDLINE, EMBASE, Cochrane Library, Scopus, CINAHL, IPA, and Global Health were searched for studies in English and French, from the database inception to October 2020. We studied outcomes including Low Birth Weight (LBW), birth weight, birth height, and head circumference. We included both experimental and observational studies and random effects models were used for meta-analysis.

Results: We screened 15,720 citations, 4279 were excluded after deduplication, 11,381 articles were excluded after title, abstract, and full-text review, and a total of 65 studies were finally included after an updated search. LBW: We identified 20 studies, including fifteen with full data to conduct meta-analysis. The primary LBW meta-analysis compared women exposed to any antiepileptic drug in-utero with unexposed women, showing a significant increased risk of LGA; RR 1.54 (95% CI 1.33 to 1.77, I2= 67%). Three studies examined the class effect of all AEDs (i.e., unspecified), showing a significant increased risk of LBW; pooled RR=1.58 (95% CI 1.21 to 2.08, I2 = 89%). 9 studies compared exposed vs. unexposed women with epilepsy, showing a statistically increased risk of LBW: pooled RR 1.17 (95% CI 0.93 to 1.48, I2= 50%). AED polytherapy was compared to monotherapy in 5 studies, showing a significantly increased risk of LBW: pooled RR=1.68 (95% CI 1.29 to 2.18, I2 = 0%). For secondary. Birth weight: 19 studies were included in the meta-analysis where we found that women who were exposed to AEDs during pregnancy had a mean difference of -118.87 (-161.03, -76.71,I2 = 42%)) g of body weight compared with unexposed women. Birth height: meta-analysis of 10 studies found a statistically insignificant mean difference of -0.18 (95%CI (-0.39, 0.03,I2 = 22%)) cm. Head circumference: 10 studies included in the meta-analysis found a statistically insignificant mean difference of 0.33 (95%CI (-0.55, 1.21,I2 = 96%)) cm.

Conclusions: This meta-analysis demonstrates that women taking any AED during pregnancy have a significantly increased risk of LBW compared to unexposed women. Polytherapy was associated with higher LBW risk compared to monotherapy. There was significant decrease of birth weight in exposed compared with unexposed women. Both birth height and head circumference had statistically insignificant results prompting for a need for more studies to study the outcome.