The outcomes of consecutive pregnancies in Australian women with epilepsy

OBJECTIVE: To investigate the extent to which seizure control and the occurrence of fetal malformation in an initial pregnancy can serve to anticipate the outcome in the next pregnancy. METHODS: We analyzed the records of the Raoul Wallenberg Australian Register of Antiepileptic Drugs in Pregnancy for seizure control and fetal malformation data for women with epilepsy taking antiseizure medication in consecutive pregnancies. RESULTS: Seizure freedom rates throughout pregnancy were higher in the subsequent pregnancy than in the initial one (60.8% vs. 52.9%; RR 1.15, 95% CI 1.03, 1.28), particularly when the nature of antiseizure therapy was unchanged between pregnancies. Fetal malformation occurrence rates (5.9% and 6.2%, respectively) were similar, but tended to be higher in women with generalized rather than focal epilepsies (7.9% vs. 4.28%; RR 1.84, 95% CI 0.89, 3.81). If a small cohort with fetal malformations in both the initial and subsequent pregnancies (7 women, 8 pairs of pregnancies) was excluded, the RR value was smaller (1.24). All but one woman in this cohort had generalized epilepsies. The birth of a malformed baby tended to occur more frequently in the next pregnancy for women with generalized epilepsy and a malformed baby in the previous pregnancy than in similar women with focal epilepsies (50% vs. 7.7%; RR 6.5, 95% CI 0.92, 45.1). SIGNIFICANCE: Compared with women with focal epilepsies, antiseizure medication-treated women with generalized epilepsy who give birth to a malformed baby appear to have a substantially greater risk of another malformed baby in their next pregnancy. Overall, seizure freedom rates were higher in subsequent pregnancies than in initial ones.