FETOMATERNAL OUTCOME IN EPILEPSY IN PREGNANCY IN A TERTIARY CARE HOSPITAL

study. These patients were managed with a team of neurologist, obstetrician, radiologist and a neonatologist. The patients were thoroughly examined, assessed and monitored regarding the fetomaternal outcome. Results: In our study, we have included 130 epilepsy patients. The incidence of epilepsy in pregnancy in our hospital is 0.54%. The mean age of participating women in our study was 24.7+8.63 years. 41 (31.5%) were using Lamotrigine as antiepileptic drug in pregnancy, gestational hypertension was the most common maternal complication in 28 (21.5%). Mode of delivery was LSCS in majority of the women i.e. 74 (56.9%). Conclusion: These women should be managed with monotherapy at the lowest possible dosage to diminish the risk of complications and also maintain good seizure control. The perinatal complications can be diminished by the close coordination between the Neurologists, Obstetrician and the Pediatrician.

Infants born to mothers with epilepsy and exposed to antiepileptic drugs (AEDs) in utero have increased risk for birth defects (4-6%) when compared with infants not exposed (1-2%) to these drugs [5][6][7][8][9][10][11][12][13] . Unfavorable neurologic and cognitive long-term development also recently was reported to be more frequent in children born to mothers with epilepsy than in controls, in spite of the great individual variation [14][15][16] , and recent studies suggested that schoolaged children of mothers with epilepsy have more additional educational needs than do controls 17 . However, many factors other than AED exposure may contribute to the observed neurodevelopmental, cognitive, and psychosocial problems in these children. These confounding factors include, for example, seizures during pregnancy, the seizure/epilepsy/epilepsy syndrome type of the mother, genetic factors, maternal age/parity, mother's cognitive functioning, and socioeconomic status 10,18 .
Although guidelines on the management of pregnant women with epilepsy have been published for neurologists 13,15 , recent reports from the United States and the United Kingdom suggest that antenatal care offered to women with epilepsy does not follow currently recommended optimal care practices 17,18 .
Pregnant women with epilepsy have a 4-8% chance of giving birth to a child with a major malformation as compared to only 2 to 4% of the general population [19][20][21] . Frequency of seizures is increased during pregnancy in onethird of women with epilepsy 19,22 .
The type of anomalies occurring in infants born to pregnant women with epilepsy are orofacial clefts, cardiac diseases and neural tube defects which affects the child's life seriously. In pregnant mothers with epilepsy on one AED this occurs in 4 to 8% and is probably greater in those receiving more than one AED 21,23 .

Objective:-
To assess thefetomaternal outcome in pregnancy with epilepsy in Jammu.

Methodology:-
This prospective study was conducted over a period of one year in the Department of Obstetrics and Gynecology, SMGS Hospital, a tertiary care center, Jammu, India. Total 130 epilepsy cases were included in this study. These patients were managed with a team of neurologist, obstetrician, radiologist and a neonatologist. The patients were thoroughly examined, assessed and monitored regarding the feto-maternal outcome. The study also includes the assistance of the Radiodiagnosis department for antenatal ultrasound and anomaly scan, the Cardiology department for the fetal echocardiography, and Biochemistry department for the alphafetoprotein levels and the serum concentrations of antiepileptic drugs. Those patients who attended the antenatal clinic with epilepsy were further monitored for different parameter assessment for the subsequent visits.
Maternal variables analysed were age, parity, duration of epilepsy, seizure during pregnancy, antiepileptic drug usage in pregnancy, maternal complications and mode of delivery. Fetal outcome variables observed were number of live birth, still birth, birth weight, Apgar score, observation of congenital anomalies and other perinatal complications. Maternal and fetal outcome variables were presented as frequencies and percentages.

Statistical Analysis:
The recorded data was compiled and entered in a spreadsheet (Microsoft Excel) and then exported to data editor of SPSS Version 20.0 (SPSS Inc., Chicago, Illinois, USA). Continuous variables were expressed as Mean±SD and categorical variables were summarized as frequencies and percentages. Graphically the data was presented by bar and pie diagrams.

Discussion:-
Pregnancy in a mother with epilepsy brings about several concerns including the risk of recurrent seizures, seizure aggravation, changes in drug levels because of altered pharmacokinetics and medication compliance and also because of the potential teratogenic effect of the AEDs 22,24 . Pregnant women with epilepsy have a 4-8% chance of giving birth to a child with a major malformation as compared to only 2 to 4% of the general population 19,20,25 .
In our study of 130 patients only 2 (1.5%) was the maternal mortality. Out of the expired 2 mothers, one died due to meningioma brain and the other due to cardiac arrest (case of epilepsy with severe anemia leading to cardiac failure). In a study done by Raji C et al (2017) 26 one motherdied due to Acute pulmonary edema due to severe preeclampsia.The frequency of death at delivery hospitalization was 80 deaths per 100 000 (0.080%) pregnancies for women with epilepsy in a study done by MacDonald SC et al (2015) 30 in their study pregnant women with epilepsy were 69,385.