Malformações fetais, defeitos de desenvolvimento e sinais dismorficos em filhos de mães com epilepsia / Fetal malformations, development defects and dysmorphic signs in outcomes of women with epilepsy

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

Rationale: The majority of women with epilepsy do not experience significant changes during pregnancy; however the persistence of seizures and the effect of antiepileptic drugs (AED) may affect the fetus. These effects include lower intrauterine growth, dysmorphisms, fetal malformation and neuropsicomotor developmental delay. Most studies report that the risk of fetal malformation is two to three times higher in fetus exposed to AED. Objectives: The goals of our study were: to identify the occurrence of fetal malformation in children of woman with epilepsy (WWE); to determine the occurrence of intrauterine developmental delay; to investigate the growth and development of these children; to describe labor complications; and to assess birth and child outcome. Methods: From May 2003 to May 2007 we evaluated 67 WWE in 69 gestations, ages ranging from 17 to 37 years, average 26.9 years. Those patients were compared with 66 non-epileptic pregnant women (control group) with 68 gestations, ages ranging from 15 to 44 years, average 26.9 years. Patients were referred from the Epilepsy Unit and Medical Genetics section of Hospital das Clínicas ? Unicamp. Results: Two WWE abandoned the study, although the data of one of them were recover. Forty women of the non-epileptic group quitted the study but we were able to recovered the data of 21 of these women reporting on the delivery and fetal malformations. Twenty-one women had their information lost. Follow-up was obtained in 52 WWE and 26 control women. Forty-five women were on one AED, 13 were on two AED and two were on three. Carbamazepine was used by 38 pregnant women, 26 were in monotherapy and 12 were in polytheraphy. Phenobarbital was the second most used AED, seven in monotherapy and five in polytheraphy. Three patients were on no medication. All patients were seen by the same neurologist, monthly during pregnancy and the post gestation period. In addition, anthropometric and neurological evaluation were performed by a geneticist at birth period, six month, 1, 2, 5 and 7 years of age. Three children of WWE presented complications: hypoxic ischemic encephalopathy (1), abruptio placentae (1) and pneumothorax (1). Low birth weight was identified in children of WWE. There was no difference in the Apgar scores in the first and fifth minutes, and head circunference in the two groups. Ten (16.39%) children from WWE (urogenital anomalies ? 2, cleft lip+cleft palate ? 1, gastrointestinal defects ? 1, skeletal defects ? 1, hernia ? 2, congenital deafness ? 3) and two (3.92%) of the control group (cardiac defects ? 2) showed major fetal malformations. Dysmorphic signs such as ear anomalies (28.85%), hypertelorism (62.96%), and small head circumference, were more frequent in children of epileptic mother, particularly associated with use of phenobarbital and complex partial seizures. Conclusions: We conclude that major fetal malformations were more frequent in children of WWE (16.39%) compared to controls (3.92%). Children of mothers with complex partial seizures, using phenobarbital presented more ear anomalies (28.85%), increased intercantal distance (62.96%) and smaller head circunference (14.29%) in longitudinal follow-up. Furthermore, abortions (1), perinatal (1) and infantile death (2) occurred only in children of WWE

ASSUNTO(S)

feto - desenvolvimento fetus anticonvulsivantes abnormities anticonvulsivant pregnancy anormalidades gravidez

ACESSO AO ARTIGO

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