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Cardiac Malformations Are Increased in Infants of Mothers with Epilepsy

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Abstract

We aimed to ascertain the prevalence of cardiac malformation (CM) and its association with antenatal exposure to an antiepileptic drug (AED) in infants of mothers with epilepsy (IMEs). Women with epilepsy (WWE) are enrolled in Kerala Registry of Epilepsy and Pregnancy (KREP) in the prepregnancy or early pregnancy period and are followed up with a standard protocol until the IMEs are 6 years old. At 3 months postpartum, a cardiologist, blinded to the AED exposure, carried out a clinical examination and echocardiography on all live-born babies. Patent foramen ovale (PFO) and interatrial septal defects of < 5 mm in size were excluded from CM. Details of maternal epilepsy, folate usage, AED exposure in the first trimester, and newborn characteristics were abstracted from the records of the KREP. We examined 462 babies. Maternal epilepsy was generalized in 201 (43.50%) or localization related in 241 (52.2%). The AED exposure was monotherapy in 262 (56.7%)—carbamazepine (112), valproate (71), phenobarbitone (43), phenytoin (31), and clonazepam (2)—and polytherapy in 126 (27.3%). Seventy-four infants (16.01%) had no AED exposure. There were 36 infants with CM (7.8%; 95% confidence interval: 5.5–10.6). CMs included atrial septal defect (26; 72.2%), tetrology of Fallot (3; 8.3%), patent ductus arteriosus and pulmonic stenosis (2 each; 5.6%), and ventricular septal defect, tricuspid regurgitation, transposition of great arteries (1 each; 2.8%). CMs were significantly more for IMEs with premature birth (p < .003). There was no association between CM and maternal age, epilepsy syndrome, seizure frequency during pregnancy, and folate use. CMs were more frequent with polytherapy (13; 10.3%) compared to monotherapy (17; 6.5%). Those with valproate exposure had a trend (not statistically significant) toward higher frequency of CM compared to IMEs on other AEDs as monotherapy.

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Acknowledgment

The Kerala Registry of Epilepsy and Pregnancy is supported by a grant-in-aid from the Kerala Council of Science Technology and Environment, the Indian Epilepsy Society, and the Indian Council of Medical Research.

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Authors and Affiliations

  1. Kerala Registry of Epilepsy and Pregnancy, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India

    S. V. Thomas, B. Ajaykumar, K. Sindhu & P. S. Sarma

  2. Kerala Registry of Epilepsy and Pregnancy, Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India

    E. Francis, N. Namboodiri, S. Sivasankaran & J. A. Tharakan

Authors
  1. S. V. Thomas
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  2. B. Ajaykumar
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  3. K. Sindhu
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  4. E. Francis
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  5. N. Namboodiri
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  6. S. Sivasankaran
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  7. J. A. Tharakan
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  8. P. S. Sarma
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Correspondence to S. V. Thomas.

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Thomas, S.V., Ajaykumar, B., Sindhu, K. et al. Cardiac Malformations Are Increased in Infants of Mothers with Epilepsy. Pediatr Cardiol 29, 604–608 (2008). https://doi.org/10.1007/s00246-007-9161-4

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  • DOI: https://doi.org/10.1007/s00246-007-9161-4

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