癫痫孕妇围产期和孕产妇发病率及死亡率风险。

IF 20.4 1区 医学 Q1 CLINICAL NEUROLOGY
Neda Razaz, Jannicke Igland, Marte-Helene Bjørk, K S Joseph, Julie Werenberg Dreier, Nils Erik Gilhus, Mika Gissler, Maarit K Leinonen, Helga Zoega, Silje Alvestad, Jakob Christensen, Torbjörn Tomson
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引用次数: 0

摘要

重要性:孕产妇癫痫与不良的妊娠和新生儿结局有关。更好地了解这种情况以及分娩时相关的死亡和发病风险有助于减少不良后果:目的:确定患有癫痫的妇女在孕产期和围产期严重发病和死亡的风险:这项基于人口的前瞻性登记研究于 1996 年 1 月 1 日至 2017 年 12 月 31 日在丹麦、芬兰、冰岛、挪威和瑞典进行。数据分析于 2022 年 8 月至 2023 年 11 月进行。参与者包括所有妊娠 22 周或以上的单胎新生儿。出生体重或孕周信息缺失或无效的新生儿被排除在外。研究小组确定了 4 511 267 例分娩,其中 4 475 984 例分娩的产妇无癫痫,35 283 例分娩的产妇有癫痫。产前接触抗癫痫药物(ASM)是指产妇从受孕到分娩期间的任何处方用药:主要结果和测量指标:妊娠期或产后 42 天内发生的孕产妇严重发病率和死亡率,以及出生后 28 天内新生儿严重发病率(如新生儿惊厥)和围产期死亡率(如死胎和死亡)。使用带 logit 链接的多变量广义估计方程得出调整后的几率比(aORs)和 95% CIs:结果:癫痫队列中妇女的平均(标清)分娩年龄为29.9(5.3)岁。与无癫痫妇女相比,癫痫妇女的孕产妇综合严重发病率和死亡率也更高(每 1000 例分娩中有 36.9 例与 25.4 例)。患有癫痫的产妇的死亡风险(每 1000 例分娩中有 0.23 例死亡)也明显高于未患癫痫的产妇(每 1000 例分娩中有 0.05 例死亡),aOR 为 3.86(95% CI,1.48-8.10)。特别是,产妇癫痫与严重子痫前期、栓塞、弥散性血管内凝血或休克、脑血管事件和严重精神健康状况的几率增加有关。患有癫痫的妇女的胎儿和婴儿的死亡率(aOR,1.20;95% CI,1.05-1.38)和新生儿严重发病率(aOR,1.48;95% CI,1.40-1.56)的几率较高。在仅限于癫痫妇女的分析中,与未接触 ASM 的妇女相比,接触 ASM 的妇女患严重孕产妇疾病的几率更高(aOR,1.24;95% CI,1.10-1.48),其新生儿的死亡率和严重发病率的几率也更高(aOR,1.37;95% CI,1.23-1.52):这项跨国研究表明,患有癫痫的妇女在孕期和产后发生严重孕产妇和围产期结局的风险要高得多,死亡风险也会增加。孕产妇癫痫和孕产妇使用 ASM 与孕产妇发病率、围产期死亡率和发病率增加有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Risk of Perinatal and Maternal Morbidity and Mortality Among Pregnant Women With Epilepsy.

Importance: Maternal epilepsy is associated with adverse pregnancy and neonatal outcomes. A better understanding of this condition and the associated risk of mortality and morbidity at the time of delivery could help reduce adverse outcomes.

Objective: To determine the risk of severe maternal and perinatal morbidity and mortality among women with epilepsy.

Design, setting, participants: This prospective population-based register study in Denmark, Finland, Iceland, Norway, and Sweden took place between January 1, 1996, and December 31, 2017. Data analysis was performed from August 2022 to November 2023. Participants included all singleton births at 22 weeks' gestation or longer. Births with missing or invalid information on birth weight or gestational length were excluded. The study team identified 4 511 267 deliveries, of which 4 475 984 were to women without epilepsy and 35 283 to mothers with epilepsy.

Exposure: Maternal epilepsy diagnosis recorded before childbirth. Prenatal exposure to antiseizure medication (ASM), defined as any maternal prescription fills from conception to childbirth, was also examined.

Main outcomes and measures: Composite severe maternal morbidity and mortality occurring in pregnancy or within 42 days postpartum and composite severe neonatal morbidity (eg, neonatal convulsions) and perinatal mortality (ie, stillbirths and deaths) during the first 28 days of life. Multivariable generalized estimating equations with logit-link were used to obtain adjusted odds ratios (aORs) and 95% CIs.

Results: The mean (SD) age at delivery for women in the epilepsy cohort was 29.9 (5.3) years. The rate of composite severe maternal morbidity and mortality was also higher in women with epilepsy compared with those without epilepsy (36.9 vs 25.4 per 1000 deliveries). Women with epilepsy also had a significantly higher risk of death (0.23 deaths per 1000 deliveries) compared with women without epilepsy (0.05 deaths per 1000 deliveries) with an aOR of 3.86 (95% CI, 1.48-8.10). In particular, maternal epilepsy was associated with increased odds of severe preeclampsia, embolism, disseminated intravascular coagulation or shock, cerebrovascular events, and severe mental health conditions. Fetuses and infants of women with epilepsy were at elevated odds of mortality (aOR, 1.20; 95% CI, 1.05-1.38) and severe neonatal morbidity (aOR, 1.48; 95% CI, 1.40-1.56). In analyses restricted to women with epilepsy, women exposed to ASM compared with those unexposed had higher odds of severe maternal morbidity (aOR ,1.24; 95% CI, 1.10-1.48) and their neonates had an increased odd of mortality and severe morbidity (aOR, 1.37; 95% CI, 1.23-1.52).

Conclusion and relevance: This multinational study shows that women with epilepsy were at considerably higher risk of severe maternal and perinatal outcomes and increased risk of death during pregnancy and postpartum. Maternal epilepsy and maternal use of ASM were associated with increased maternal morbidity and perinatal mortality and morbidity.

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来源期刊
JAMA neurology
JAMA neurology CLINICAL NEUROLOGY-
CiteScore
41.90
自引率
1.70%
发文量
250
期刊介绍: JAMA Neurology is an international peer-reviewed journal for physicians caring for people with neurologic disorders and those interested in the structure and function of the normal and diseased nervous system. The Archives of Neurology & Psychiatry began publication in 1919 and, in 1959, became 2 separate journals: Archives of Neurology and Archives of General Psychiatry. In 2013, their names changed to JAMA Neurology and JAMA Psychiatry, respectively. JAMA Neurology is a member of the JAMA Network, a consortium of peer-reviewed, general medical and specialty publications.
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