صرع و اختلالات تغذیه ای در دوران بارداری: شیوع، عوارض و نتایج تولد

Purpose The aim was to investigate the prevalence of eating disorders and its relation to pregnancy and delivery complications in childbearing women with epilepsy (WWE). Method This study is based on The Norwegian Mother and Child Cohort Study (MoBa) linked to the Medical Birth Registry of Norway. Epilepsy was reported in 706 pregnancies. The remaining cohort (n = 106,511) served as the reference group. Eating disorders were diagnosed using DSM-IV criteria adjusted for pregnancy. The risk of preeclampsia, gestational hypertension, diabetes and weight gain during pregnancy as well as delivery outcome (small for gestational age, large for gestational age, ponderal index, low APGAR score, small head circumference) were calculated as odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for maternal age, smoking, parity and socioeconomic factors. Results Pregnant WWE were significantly more likely to have binge eating disorder (6.5% vs. 4.7%, p < 0.05). WWE and comorbid eating disorders had significantly more preeclampsia (7.9% vs. 3.7%, p < 0.05), peripartum depression and/or anxiety (40.4% vs. 17.8%, p < 0.001) and operative delivery (38.2% vs. 23.5%, p < 0.001) than the reference group without epilepsy or eating disorders. After adjustment for confounders, a significantly increased risk of operative delivery (OR 1.96, CI 1.26–3.05) and peripartum depression and/or anxiety (OR 2.17, CI 1.40–3.36) was demonstrated. Conclusion Eating disorders in WWE contribute to the increased risk of pregnancy and delivery complications. Health personnel should be aware of eating disorders in WWE and refer them for treatment before pregnancy.

Antiepileptic drug (AED) treatment is used by 0.2–0.7% of pregnant women [1] and [2]. Several obstetrical complications such as preeclampsia, gestational hypertension, caesarian delivery, congenital malformations and low birth weight occur more frequently in these women than in women without epilepsy [3]. Adverse birth outcomes in women with epilepsy (WWE) are believed to be mediated by AED use, although the exact mechanisms of action and the role of confounding factors remain unclear. Comorbid eating disorders (ED) are an unexplored potential contributor to pregnancy complications in WWE. Using data from The Norwegian Mother and Child Cohort Study (MoBa), Reiter et al. [4] found an increased life time prevalence of self-reported, unspecified ED in pregnant WWE. Rai et al. also found an increased frequency of ED (OR 2.9) in non-pregnant persons with epilepsy [5]. Adverse pregnancy outcomes are more frequent in women with ED, especially for the subgroup with binge eating disorder (BED) [6]. Women with BED deliver babies that are large for gestational age and have an increased risk of caesarian section. An increased rate of miscarriages has been noted in both anorexia nervosa (AN) and bulimia nervosa (BN) [7] and [8]. ED have also been linked to an increased risk of stillbirth, low birth weight, low Apgar scores, breech presentation, lower weight-for-length offspring trajectories and cleft lip and palate [9], [6] and [10]. As both epilepsy and ED increase the risk of complications during pregnancy and delivery, we investigated the prevalence and subtypes of this combination during pregnancy, and estimated possible impacts of ED in epilepsy on pregnancy and birth outcome in WWE.

The increased risk for complications in WWE with ED during pregnancy with possible adverse health effects for both mother and child should be considered and minimized in consultations both before and during pregnancy.