Excess mortality no longer seen among the children of mothers with epilepsy

Diet and lifestyle 10. apr 2022 2 min Clinical Associate Professor Jakob Christensen Written by Kristian Sjøgren

New research shows that the children of mothers with epilepsy previously had an increased risk of dying within the first year of life but the excess mortality was no longer seen after 2000. This is reassuring, says the researcher, who especially highlights doctors, midwives and nurses as the potential reason for the positive trend.

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New research from Aarhus University and Aarhus University Hospital concludes that children born to mothers with epilepsy after 2000 do not have an increased risk of dying within the first year of life.

The researchers analysed data on pregnant women with epilepsy and their children from 1981 to 2016. Although the children of women with epilepsy born before 2000 clearly had excess mortality, this was not found in children born after 2000.

This is good news, says a researcher behind the study.

“The care of pregnant women with epilepsy seems to have improved, which benefits both the women and their children,” explains Jakob Christensen, Clinical Associate Professor and Consultant, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital.

The research has been published in the Annals of Neurology.

The children of mothers with epilepsy have major challenges

Researchers have long studied pregnant women with epilepsy and their children.

One reason is several negative associations between pregnant women with epilepsy and being the child of a mother with epilepsy. The children of mothers with epilepsy who received certain types of medication during pregnancy have a high risk of developing autism, intellectual disability and attention-deficit/hyperactivity disorder. These children do not perform as well in school and have an increased risk of low birth weight.

Jakob Christensen’s research group has found that prenatal exposure to the antiseizure drug valproate subsequently increases the child’s risk of congenital malformations and developmental and behavioural disorders.

“Our study and others have found that the risk is not limited to the woman being pregnant and having epilepsy. Antiseizure medication can also affect the children, and we should be concerned about this,” says Jakob Christensen.

Examined data from more than 1.8 million children

The researchers investigated whether the children of mothers with epilepsy have excess mortality.

The researchers obtained data from 1981 to 2016 for more than 1.8 million children from the Danish Medical Birth Registry, Danish Registry of Causes of Death, Danish National Patient Registry and Danish National Prescription Registry.

The researchers analysed a wide range of outcomes, including the risk of death within the first year and the causes of death.

“One might fear that the children of women with epilepsy have excess mortality because the women have seizures, which can harm their child if the seizure leads to, for example, an accident,” explains Jakob Christensen.

Several interesting results

The study found several interesting results.

· Older children of women with epilepsy have no increased risk of dying.

· The children of women with epilepsy born between 1981 and 1999 had a 65% increased risk of dying in the first year of life compared with the children of women without epilepsy.

· The children born to women with epilepsy after 2000 had no increased risk of dying.

· The children born to women who had received antiseizure medication for epilepsy during pregnancy had a 51% greater risk of dying.

· The children who died within their first year of life died primarily from natural causes rather than accidents.

Jakob Christensen emphasises the positive trend that women with epilepsy should no longer worry about whether their child has an increased risk of dying within the first year.

“The fact that the children of women with epilepsy no longer have excess mortality in the first year of life is gratifying. However, the children of women with epilepsy still have challenges, and we still need to determine whether these challenges result from the mother’s epilepsy or from the mother taking antiseizure medication during pregnancy,” says Jakob Christensen, who adds that his research is helping to elucidate some of these questions.

Improved care is probably the explanation

According to Jakob Christensen, fewer children of women with epilepsy dying today than before may result from the fact that doctors, midwives and nurses have improved the monitoring of pregnant women with epilepsy.

Perhaps doctors have improved the monitoring of their patients when they become pregnant or perhaps choose drugs that are not as strongly associated with increased risks to the baby.

“Doctors, midwives and nurses may have become better at giving women with epilepsy appropriate care. Neurologists can also take some credit for this combined care. However, we can at least conclude that the numerous concerns that both women with epilepsy and healthcare professionals may have about pregnancy and childbirth are not reflected in increased mortality among children. However, remember that the children of mothers with epilepsy may still face many challenges, although increased mortality fortunately does not seem to be one of them,” concludes Jakob Christensen.

Maternal epilepsy and long-term offspring mortality: a nationwide cohort study” has been published in the Annals of Neurology. The Central Denmark Region, the Danish Epilepsy Association and the Novo Nordisk Foundation supported the research through the project Epilepsy and Psychiatric Comorbidity (EpiPsyk) – Genetic and Environmental Causes and Consequences of Epilepsy and Psychiatric Comorbidity.

In his research Jakob Christensen incorporates data which combines information from Danish social and health registers and biobanks. Biobanks have gat...

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