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Journal article
First-trimester use of antiseizure medications and the risk of miscarriage: a population-based cohort study
Journal of neurology, neurosurgery and psychiatry, v 95(8), pp 693-703
22 May 2024
PMID: 38777577
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background
Antiseizure medications (ASMs) during the first trimester of pregnancy have been associated with an increased risk of miscarriage.
Methods
We carried out a population-based cohort study using routinely collected healthcare data from the UK, 1995–2018. Pregnancies were identified in the Clinical Practice Research Datalink and we estimated the HR of miscarriage associated with prescriptions of ASMs during the first trimester of pregnancy, using Cox regression, adjusting for potential confounders, including ASM indications.
Results
ASMs were prescribed during the first trimester in 7832 (0.8%) of 1 023 787 included pregnancies. 14.5% of pregnancies with first-trimester exposure to ASMs ended in miscarriage, while 12.2% without ASM exposure in the first trimester ended in miscarriage; after adjustment, there was a 1.06-fold relative hazard of miscarriage (95% CI 1.00 to 1.13) in women with first-trimester ASM use. After restricting to women with specific ASM indications, this association was not evident in women with epilepsy (adjusted HR 0.98, 95% CI 0.89 to 1.08), but was observed in women with bipolar or other psychiatric conditions (1.08, 95% CI 1.00 to 1.16) although CIs overlapped. Compared with discontinuation of ASMs prior to pregnancy, there was no evidence of increased risk of miscarriage for first-trimester ASM use in women with bipolar or other psychiatric conditions (1.02, 95% CI 0.87 to 1.20).
Conclusion
We found no clear evidence to suggest that first-trimester ASM use increased the risk of miscarriage. Taken together, our analyses suggest that apparent associations between first-trimester ASM use and miscarriage may be the result of confounding by the presence of a bipolar disorder or associated unmeasured variables.
Metrics
Details
- Title
- First-trimester use of antiseizure medications and the risk of miscarriage: a population-based cohort study
- Creators
- Harriet Forbes - London School of Hygiene & Tropical MedicinePaul Madley-Dowd - University of BristolViktor Ahlqvist - Karolinska InstitutetJennifer Campbell - Clinical Practice Research DatalinkNeil M Davies - University of BristolRachel Liebling - National Health ServiceKristen Lyall - Drexel UniversityCraig Newschaffer - Pennsylvania State UniversityJessica Rast - Drexel UniversityTorbjörn Tomson - Karolinska InstitutetCaichen Zhong - Drexel UniversityCecilia Magnusson - Karolinska InstitutetDheeraj Rai - University of BristolBrian K Lee - Karolinska Institutet
- Publication Details
- Journal of neurology, neurosurgery and psychiatry, v 95(8), pp 693-703
- Publisher
- BMJ Publishing Group Ltd
- Number of pages
- 11
- Grant note
- 295989 / Norges Forskningsråd (http://dx.doi.org/10.13039/501100005416) 1R01NS107607 / National Institutes of Health (http://dx.doi.org/10.13039/100000002) 218495/Z/19/Z / Wellcome Trust (http://dx.doi.org/10.13039/100010269) MC_UU_00011/1; MC_UU_00011/3; MC_UU_00011/7 / Medical Research Council (http://dx.doi.org/10.13039/501100000265)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics; A.J. Drexel Autism Institute
- Web of Science ID
- WOS:001229584800001
- Scopus ID
- 2-s2.0-85199125588
- Other Identifier
- 991021880395204721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Clinical Neurology
- Psychiatry
- Surgery