Pregnancy, delivery, and neonatal complications after treatment with antiepileptic drugs

Aim. To study the risk for complications during pregnancy, delivery, and neonatal period after the use of antiepileptic drugs (AEDs) during pregnancy. Methods. Women treated with AEDs during pregnancy and with singleton deliveries were identified from the Swedish Medical Birth Registry during the period July 1 1995 to and including 2001 (n = 1350). Risk estimates were made using the Mantel-Haenszel procedure and comparisons with all singleton births in Sweden during this period (n = 559 491). Stratification was made for year of birth, maternal age, parity, and smoking habits. Results. Most of the women (n = 1207, 89%) used AEDs in monotherapy. Carbamazepine was the most commonly used drug (n = 683), followed by valproic acid (n = 255). The rate of caesarean sections was significantly increased (OR = 1.64, 95% CI 1.43-1.89), but it was not possible to differentiate between elective and emergency sections. The risk for pre-eclampsia (OR = 1.66, 95% CI 1.32-2.08) and for hemorrhage after vaginal delivery was increased (OR = 1.29, 95% CI 1.02-1.63). The neonates showed an increased risk for respiratory distress (OR=2.06, 95% CI 1.62-2.63). Conclusion. The study demonstrates a slightly increased risk only for preeclampsia, vaginal hemorrhage after delivery, and respiratory distress in the newborn after the use of AEDs during pregnancy.