(238) Uses of Antiepileptic Drugs Among Pregnant Women with Epilepsy and Risk of Adverse Obstetric Outcomes; a Group-Based Trajectory Analysis

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 569

Presenting Author(s)

yi_chin lin
– Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taipei, Taiwan

Co-Author(s)

Chih-Wan Lin
– Taiwan Drug Relief Foundation, Taipei, Taiwan (Republic of China)
Shih-Tsung Huang, PharmD
– Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
Fei-Yuan Hsiao
– Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan (Republic of China)

Background: Women with epilepsy have greater risk of preterm birth than those without epilepsy, which highlights the importance of seizure control in pregnant women. However, conflicting data have been reported in terms of the association between antiepileptic drugs (AEDs) use and adverse obstetric outcomes, such as preterm birth, low birth weight (LBW), and small for gestational age (SGA). In addition, whether the duration and timing of AEDs use during pregnancy have any impact on risk of adverse obstetric outcomes remained unanswered.

Objectives: The aim of this nationwide study is thus to evaluate the association between different exposure patterns of AEDs and adverse obstetric outcomes in pregnant women with epilepsy.

Methods: This is a retrospective cohort study retrieving data from the Birth Certificate Application and National Health Insurance Research Dataset (NHIRD) in Taiwan from 2004 to 2018. We assessed weekly consumption of AEDs among pre-pregnancy chronic AEDs users with epilepsy and used group-based trajectory modeling to identify distinct groups of AEDs use from 84 days before conception of pregnancy to 2nd trimester of pregnancy. Covariates included maternal age, severity of epilepsy, other indications for AEDs, comorbidities, comedication, sex and birth year of infant. Logistic regression model was used to examine the association between distinct trajectories of AEDs use prior and during pregnancy and risk of preterm, LBW, and SGA.

Results: Among 2,882,603 pregnant women, we identified 2175 pregnant women with epilepsy and chronically used AEDs one year prior to pregnancy. For eligible pregnant women, we identified 4 distinct trajectories of AEDs uses from pre-pregnancy to 2nd trimester: frequent and continuous users (n=1411, 64.9 %), frequent but discontinuous users (n=154, 7.1%), intermittent users (n=429, 19.7 %), and intermittent and discontinuous users (n=181, 8.3%). Different trajectory groups versus frequent and continuers had no significant different odds of preterm (frequent but discontinuers: aOR 0.83 [95% CI 0.47-1.48]; intermittent: 0.71 [0.47-1.05]; intermittent and discontinuers: 0.88 [0.52-1.49]), LBW (frequent but discontinuers: 0.89 [0.51-1.56]; intermittent: 0.70 [0.47-1.04]; intermittent and discontinuers: 1.34 [0.84-2.12]), SGA (frequent but discontinuers: 0.95 [0.58-1.57]; intermittent: 0.92 [0.66-1.28]; intermittent and discontinuers: 0.98 [0.62-1.56]).

Conclusions: No significant difference between the association between distinct trajectories of AEDs use and risk of adverse obstetric outcomes was found in this study. However, the wide confidence interval indicates that a larger sample size may be warranted to yields enough statistical power.