Effects of epilepsy and antiepileptic drugs on fetal cardiac functions: A cross-sectional study from a tertiary center

Aim

This study aimed to assess fetal cardiac function in response to epilepsy and antiepileptic drugs.

Methods

This cross-sectional prospective study included 31 pregnant women with epilepsy (22 on monotherapy, 9 unmedicated) and 45 randomly selected, gestational age-matched low-risk pregnant women. The mean gestational ages were comparable across groups: 30.27 ± 2.95 weeks for the monotherapy group, 30.11 ± 2.80 weeks for the unmedicated epilepsy group, and 31.13 ± 2.83 weeks for the control group (p = 0.397). Fetal cardiac function was evaluated using indices of systolic and diastolic function: isovolumetric contraction time, isovolumetric relaxation time (IRT), ejection time, myocardial performance index (MPI), mitral and tricuspid maximum early ventricular filling (E) wave velocity, maximum active atrial filling (A) wave velocity, E/A ratios, mitral and tricuspid annular plane systolic excursion, and pulmonary and aortic artery peak velocities.

Results

In the monotherapy epilepsy group, IRT was significantly prolonged (47.77 vs. 42.78 vs. 43.47, p = 0.006 and p < 0.001), and MPI was significantly increased (0.49 vs. 0.46 vs. 0.46, p = 0.027 and p = 0.194) compared to the unmedicated epilepsy and control groups. Tricuspid valve E values were significantly lower in the monotherapy epilepsy group (40.49 vs. 43.87, p = 0.034). Furthermore, IRT values were prolonged in the subgroup with seizures during pregnancy compared to those without (40.73 vs. 44.45, p = 0.001).

Conclusion

To our knowledge, this was the first study to examine the potential cardiac functional impact of epilepsy and antiepileptic drugs. This study demonstrated a small but significant association between maternal antiepileptic drug use and impaired fetal cardiac diastolic function, as assessed by ultrasound.