Danielsson KC, et al. - Researchers assessed the risk of hypertensive pregnancy complications in women with epilepsy, with and without antiepileptic drugs. They also sought to gauge the risk linked with the four most common antiepileptic drugs. A greater risk of mild pre-eclampsia was noted among women with epilepsy. This was not found for the severe types of hypertensive pregnancy complications. Findings demonstrated that lamotrigine and levetiracetam did not predispose for mild pre-eclampsia. On the other hand, valproate was related with an increased risk of mild pre-eclampsia.

Methods

• Using linked data from the Medical Birth Registry of Norway and the Norwegian Prescription Database, experts conducted a population-based cohort study in Norway from 2004-2012.
• Women without epilepsy were compared to those with epilepsy, both with and without antiepileptic drugs.
• The enrollment consisted of all first pregnancies of women with and without epilepsy.
• A compound variable of any hypertensive disorder, gestational hypertension, mild pre-eclampsia, severe pre-eclampsia, early onset pre-eclampsia, eclampsia and HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) served as the primary outcome.

Results

• An assessment was conducted of 1,778 pregnancies in women with epilepsy and 221,662 in women without epilepsy.
• It was noted that 682 of the women with epilepsy used antiepileptic drugs, the most common monotherapy being, lamotrigine (n=280), carbamazepine (n=94), levetiracetam (n=71) and valproate (n=51).
• A greater risk of any hypertensive disorder was reported in women with epilepsy (adjusted OR (aOR) 1.2, 95% CI 1.0 to 1.5) and in the subcategory using valproate (aOR 2.9, 95% CI 1.3 to 6.4).
• The most frequent hypertensive complication was found to be mild pre-eclampsia, with increased risk in women with epilepsy (aOR 1.4, 95% CI 1.1 to 1.8) and women with epilepsy on valproate (aOR 3.3, 95% CI 1.2 to 9.4).