August 17, 2009

Seizures During Pregnancy Linked to Premature Babies

Women with epilepsy who have seizures during pregnancy appear more likely to give birth to pre-term, small or low-birth-weight babies than women without epilepsy, according to a new report.

"While approximately 40 percent of the 18 million women with epilepsy in the world are of childbearing age," Yi-Hua Chen, Ph.D., of Tai Pei Medical University, Taiwan, and colleagues were quoted as saying, "managing maternal epilepsy and monitoring the health of the developing fetus remain some of the most perplexing and engaging issues in the fields of neurology and obstetrics."

Researchers used data from the Taiwan National Health Insurance Research Data set, analyzing records from 1,016 women with epilepsy who gave birth between 2001 and 2003. Of these, 503 had seizures during pregnancy and 513 did not. A control group of 8,128 women who were the same age and gave birth during the same years but did not have epilepsy or any other chronic disease were selected for comparison.

Women who had seizures during pregnancy were 1.36 times more likely to have a low-birth-weight baby, 1.63 times more likely to give birth before 37 weeks and had a 1.37 times greater risk of having a baby who was small for gestational age. Compared with women who had epilepsy but did not have seizures, the odds of women who had seizures during pregnancy of having a baby who was small for gestational age were 1.34 times greater.

"Our study . . . suggests that it is the seizures themselves that seem to contribute greatly to the increased risk," said the researchers. "For women who remained seizure-free throughout pregnancy, null or mild risk was identified compared with unaffected women."

There are several possible explanations for the association between seizures and adverse pregnancy outcomes. Trauma caused by a woman's seizures could rupture fetal membranes, increasing risk of infection and early delivery. Tension and acute injury may result from uterine contractions that occur during seizures. However, additional research is needed to understand how seizures interfere with fetal development.

"Neonates born pre-term, of low birth weight and small for gestational age may be predisposed to diseases during infancy and later life, highlighting the significance of proper intervention strategies for prevention," the authors wrote.

Prevention strategies could include helping women control seizures for a period of time before pregnancy, assisting them in sleeping better, providing education about the risks of seizures while pregnant and teaching improved strategies for coping with stress.

SOURCE: Archives of Neurology, August 2009