Fetal outcomes
Fetal outcomes are presented in Table 2. More pregnancies had a preterm
birth in the unplanned-pregnancy group than in the planned-pregnancy
group (20.4% vs. 3.3%; P < 0.001, Chi-square test).
The cesarean section rate was higher in the unplanned group than in the
planned group (56.3% vs. 45.1%; P = 0.023, Chi-square test).
Compared with the unplanned-pregnancy group, the planned-pregnancy group
had a significantly higher live birth rate (96.8% vs. 83.0%; P< 0.001; Chi-square test), and a lower induced abortion rate
(2.7% vs. 13.5%; P < 0.001; Chi-square test). The
planned-pregnancy group seemed to have less SFL than the
unplanned-pregnancy group, though statistical significance was not
reached (0.5% vs. 3.5%; P = 0.077, Chi-square test).
The MCM rate within one year after delivery among live births in the
unplanned group was significantly higher than that in the
planned-pregnancy group (7.5% vs. 1.6%; P = 0.006, Chi-square
test). All the three MCM cases in the planned-pregnancy group were
congenital cardiac defects, of which one was ventricular septal defect,
one was patent foramen ovale, and the other one was atrial septal
defect. Of the 18 MCMs in the unplanned-pregnancy group, there were nine
cases with congenital cardiac defects, two cases with bifid spine, two
cases with cleft lip and cleft palate, two cases with hypospadias, one
case with conjoined twins, one case with club foot, and one case with
anotia. Detailed AED treatment patterns and folic acid supplementation
for the 21 pregnancies with MCMs in the planned and unplanned group are
presented in Table S1 in the supplement. All cases of MCMs had no family
history of malformation.
Next, we pooled the pregnancies with either induced abortion, SFL,
preterm birth, or offspring with MCMs together and referred to them as
pregnancies with adverse fetal outcomes. Regression analysis
demonstrated that the risk of adverse fetal outcomes was significantly
lower for the planned pregnancies when planning was entered alone (OR,
0.13; 95% CI, 0.07-0.23; P < 0.001) or adjusted for
age at conception, whether taking VPA in either monotherapy or
polytherapy in the first trimester, the frequency of GTCS during
pregnancy, and whether receiving appropriate folic acid supplementation
(OR, 0.14; 95% CI, 0.08-0.27; P < 0.001). Regression
analysis also identified whether taking VPA during pregnancy (OR, 4.34;
95% CI, 2.09-9.00; P < 0.001), frequency of GTCS
during pregnancy (OR, 1.16; 95% CI, 1.03-1.3; P = 0.012) but not
age at conception (OR, 1.00; 95% CI, 0.94-1.07; P = 0.935), and
appropriate folic acid supplementation (OR, 1.02; 95% CI, 0.63-1.66;P = 0.941) were significant independent associated factors.