Epilepsy and pregnancy: effect of antiepileptic drugs and lifestyle on birthweight

Objective To investigate the impact of epilepsy and antiepileptic drugs on length of gestation and anthropometric measures of the newborn. Design Cohort study based on questionnaires mailed to all pregnant women wh o attended for prenatal care at our department from August 1989 to January 1997. Setting Department of Obstetrics and Gynaecology at Aarhus University Hospi tal, Denmark. Participants One hundred and ninety-three singleton pregnancies in women wi th epilepsy were compared with 24,094 singleton pregnancies in women withou t epilepsy. Main outcome measures Preterm delivery, small for gestational age, mean ges tational age, gestational age-adjusted birthweight, head circumference, and body length. Results Children of women with epilepsy who smoked had lower gestational ag e and were at increased risk of preterm delivery (OR 3.4; 95% CI 1.8-6.5), compared with children born by nonepileptic women who smoked. Birthweight a djusted for gestational age was reduced by 102 g (95% CI 40-164) in women w ith epilepsy, and the risk of delivering a child who was small for gestatio nal age was increased (adjusted OR 1.9, 95% CI 1.3-2.7), compared with wome n without epilepsy. Newborn babies of women with epilepsy treated by drugs had a reduced adjusted birthweight (208 g, 95% CI 116-300), head circumfere nce (0.4 cm, 95% CI 0.0-0.7), and body length (0.5 cm, 95% CI 0.1-1.0), com pared with the newborn infants of women without epilepsy. Conclusions Women with epilepsy who smoked were at increased risk of preter m delivery compared with healthy smokers. Children of women with drug treat ed epilepsy had lower birthweight, length, and head circumference than chil dren of women without epilepsy.