Managing reproductive problems in women with epilepsy of childbearing age

Girls and women constitute nearly 50%of all epilepsy cases.Apart from the disease symptoms,epilepsy and antiseizure medications(ASMs)may also affect the reproductive function,pregnancy and even the health of their offspring.Therefore,it is very important to identify and summarize the problems and risks for women with epilepsy(WWE)of childbearing age,and offer internationally recognized methods through multidisciplinary collaboration.In this review,we summarize the reproduction-related problems with WWE and propose multidisciplinary management by epileptologists,gynecologists and obstetricians,as well as other experts,from preconception to delivery.Large,multicenter registries are needed to advance our knowledge on new ASMs and their effects on WWE and their offspring.

Seizure frequency and obstetric complications at advanced maternal age:a preliminary observational study in women with epilepsy

Background:Seizure control during pregnancy and obstetric outcomes are of important concerns for women with epilepsy(WWE)and their families.Advanced maternal age(≥35 years)shows a growing trend in the society with changes of lifestyle,which also occurs in diseased populations.The advanced maternal age is an independent factor for some unsatisfying obstetric outcomes.In this study we explored the seizure control and obstetric complications associated with advanced maternal age in WWE.Methods:This study was based on the epilepsy pregnancy registry at West China Hospital.Patients with epilepsy in this registry who were aged 35 or older when starting pregnancy were included in this study.Their basic demographics and detailed information on epilepsy management and obstetric issues in all trimesters and during 1-year follow-up after birth were documented and reviewed.Data were processed by IBM SPSS version 22.0.The demographic characteristics,seizure frequency,treatment change,obstetric complications,and outcomes were analyzed and compared.Results:Fifteen patients were included in this study,with an average age of 36.32±2.39 years at pregnancy,and 73.33%of them were primiparas.The change of seizure frequency during pregnancy was not in a clear pattern,but there was an increased incidence of tonic-clonic seizures during the mid-and last trimesters.More than 20%of the patients had obstetric complications throughout the trimesters,including vaginal bleeding,hypothyroidism,and pre-eclampsia.The pre-eclampsia seemed extraordinarily complicated with other conditions.However,none of the complications were related with malformations or poor outcome of babies after 1-year follow-up.Conclusion:Advanced maternal age combined with WWE is associated with frequent common obstetric complications.Future controlled studies with large sample sizes are needed to explore the related risks in comparison with other WWE and non-epileptic populations.