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.