Pharmacoepidemiology
Antiseizure medication use in pregnancy and adverse neonatal birth outcomes: a Canadian multisite population-based cohort study Alekhya Lavu* Alekhya Lavu Payam Peymani Silvia Alessi-Severini Chelsea Ruth Jamison Falk Karina Kowalec Christine Leong Shelley Derksen Roxana Dragan Marcus C. Ng Brandace Winquist Joseph Delaney Sherif Eltonsy
Introduction
Antiseizure medication (ASM) exposure in utero has been associated with an increased risk of adverse birth outcomes.
Objective
We aim to study the association between ASM treatment during pregnancy and adverse neonatal outcomes among pregnant people in two Canadian provinces.
Methodology
We conducted a multisite population-based retrospective cohort study of pregnant people in Manitoba from 1998 to 2021 and Saskatchewan from 1995-2023. We examined the association between ASMs and the risk of small for gestational age (SGA), low birth weight (LBW), preterm birth, NICU admissions, infants’ length of hospital stays (LOS) (>3days), infant mortality (≤27), neonatal mortality (≤365 days), persistent pulmonary hypertension (PPHTN), neonatal respiratory distress syndrome (NRDS), severe neonatal morbidity (SNM) and neonatal readmissions among all pregnant people. Multivariate regression models were adjusted for various clinical covariates and confounders. We meta-analyzed the aggregated data from the two sites using random effects model.
Results
We included a total of 545,121 pregnancies in our analysis including 6874 exposed pregnant people. We observed a significant increase in the risk of SGA (adjusted odds ratio [aOR] 1.13, 95%CI 1.08-1.19), LBW (aOR 1.19, 95%CI 0.61-2.30), preterm birth (aOR 1.36, 95%CI 1.06-1.76), NICU admissions (aOR 1.30, 95%CI 1.08-1.57), LOS infant (aOR 1.18, 95%CI 1.05-1.31), infant mortality (aOR 1.21, 95%CI 1.02-1.44), neonatal mortality (aOR 1.23, 95%CI 1.07-1.43), PPHTN (aOR 1.38, 95%CI 1.20-1.57) and a non-significant increased risk of neonatal readmissions (aOR 1.10, 95%CI 0.94-1.29), SNM(aOR 1.08, 95%CI 0.81-1.44) and NRDS (aOR 1.06, 95%CI 0.79-1.43) when compared with unexposed pregnant people.
Conclusion
ASM exposure in pregnant people is associated with a significant increase in adverse birth outcomes. Therefore, future studies must investigate the safety of ASMs in epilepsy and non-epileptic conditions.