Impact of prenatal,neonatal,and postnatal factors on epilepsy risk in children and adolescents:a systematic review and meta-analysis

Background Epilepsy is a common,long-term neurological condition.Several previous case-control,cohort and cross-sectional studies have highlighted the role of prenatal,delivery and postnatal factors in the onset of epilepsy.In this systematic review,we evaluate the impact of these factors on the development of epilepsy in children and adolescents.Methods We searched PubMed and Google Scholar for literature on the relationship between prenatal,delivery and postnatal factors and the occurrence of epilepsy.The research was performed according to the PRSIMA 2020 flowchart and checklist.Data were extracted and pooled according to the ReviewManager 5.3 software using a random-effects model.Sensitivity analysis and subgroup analysis were used to evaluate the source of heterogeneity.Results We identified 25 reports,including 45,044 cases with confirmed epilepsy and 2,558,210 controls.Premature birth is significantly associated with the risk of epilepsy(pooled OR=4.36[95%CI:1.26–15.09],P=0.02).Smoking during pregnancy significantly increases this risk by 28%(pooled OR=1.28[95%CI:1.1–1.49],P=0.002).Furthermore,maternal epilepsy confers a pooled OR of 2.06[95%CI:1.26–3.36].Eclampsia is linked to a 16.9-fold increased risk of epilepsy.In addition,both pregnancy metrorrhagia and maternal infection are significantly associated with the epilepsy risk(pooled OR=2.24[95%CI:1.36–3.71]and 1.28[95%CI:1.17–1.41],respectively).For delivery conditions,cord prolapse(pooled OR=2.58[95%CI:1.25–5.32]),prolonged labor(>6 h)(OR=6.74[95%CI:3.57–12.71])and head trauma(pooled OR=2.31[95%CI:1.54–3.48])represent a meaningful risk of epilepsy occurrence.Moreover,birth complications(OR=3.91[95%CI:2.43–6.29]),low birth weight(pooled OR=1.83[95%CI:1.5–2.23])and male birth(pooled OR=1.18[95%CI:1.06–1.32])are associated with an elevated risk of epilepsy in childhood and adolescence.Conclusions Epilepsy in children and adolescents can be attributed to a multitude of intricate factors,notably those during pregnancy,delivery and the postnatal period.These findings highlight the crucial role of prenatal and postnatal care in reducing the impact of these factors on epilepsy occurrence.

Prenatal risk factors for internalizing and externalizing problems in childhood

Background A growing body of research has documented the effects of prenatal risk factors on a wide spectrum of adverse offspring health outcomes.Childhood behavior problems,such as externalizing and internalizing problems,are no exception.This comprehensive literature review aims to summarize and synthesize current research about commonly experienced prenatal risk factors associated with internalizing and externalizing problems,with a focus on their impact during childhood and adolescence.Potential mechanisms as well as implications are also outlined.Data sources The EBSCO,Web of Science,PubMed,Google Scholar,and Scopus databases were searched for studies examining the association between prenatal risk factors and offspring internalizing/externalizing problems,using keywords“prenatal”or“perinatal”or“birth complications”in combination with“internalizing”or“externalizing”.Relevant articles,including experimental research,systematic reviews,meta-analyses,cross-sectional and longitudinal cohort studies,and theoretical literature,were reviewed and synthesized to form the basis of this integrative review.Results Prenatal risk factors that have been widely investigated with regards to offspring internalizing and externalizing problems encompass health-related risk factors,including maternal overweight/obesity,substance use/abuse,environmental toxicant exposure,maternal infection/inflammation,as well as psychosocial risk factors,including intimate partner violence,and anxiety/depression.Collectively,both epidemiological and experimental studies support the adverse associations between these prenatal factors and increased risk of emotional/behavioral problem development during childhood and beyond.Potential mechanisms of action underlying these associations include hormonal and immune system alterations.Implications include prenatal education,screening,and intervention strategies.Conclusions Prenatal risk factors are associated with a constellation of offspring internalizing and externalizing problems.Identifying these risk factors and understanding potential mechanisms will help to develop effective,evidence-based prevention,and intervention strategies.