Introduction
Epilepsy is a common neurological disease that affects approximately 12.5 million women of childbearing age worldwide.1Compared with healthy individuals, women with epilepsy (WWE) often have increased risk of pregnancy complications, for example, gestational hypertension, pre­eclampsia, post-partum hemorrhage, antepartum hemorrhage, placental abruption premature rupture of membranes, preterm labor, and cesarean section.2-6 Furthermore, infants of WWE who take antiepileptic drugs (AEDs) are at additional risk of major congenital malformations (MCMs),7, 8neurodevelopmental delays,9 and low birth weights.10 Therefore, preconception and prenatal care to ensure a healthy pregnancy, labor, and delivery for WWE is a critical challenge.
Studies have demonstrated that good seizure control, optimized AEDs types and doses, and appropriate folic acid supplementation can benefit both WWE and their children.11-14 Notably, the newer generation AEDs such as lamotrigine (LTG), levetiracetam (LEV), and oxcarbazepine (OXC) in monotherapy have been reported to have a low risk of congenital malformations, comparable to the range as reported in unexposed offspring.15, 16 By contrast, some AEDs, for example, valproate (VPA), have substantially high risks of teratogenesis.17 Thus, preconception counseling and pregnancy management, namely, pregnancy planning, may be effective strategies to decrease the risk of pregnancy complications and offspring malformations.
Currently, a large proportion of pregnancies in WWE are unplanned. Data from the Epilepsy Birth Control Registry (EBCR) indicated that the percentage of unplanned pregnancies in WWE was up to 65%,18 and that unplanned pregnancy in WWE may double the risk for spontaneous fetal loss (SFL).19 However, the association between planned and unplanned pregnancy and offspring’s MCMs has not been studied. Here, based on the prospectively registered database for WWE and pregnancy in Xijing Hospital, we analyzed the differences in AED treatment patterns, seizure control, and folic acid supplementation between planned and unplanned pregnancy and investigated the effect of planned pregnancy in WWE on fetal outcomes.