THE IMPACT OF ANTI EPI LEPTIC TREATMENT IN PREGNANCY ON PERINATAL OUTCOME IN CROATIA--A SINGLE-CENTER STUDY/UCINAK LIJECENJA ANTIEPILEPTICIMA U TRUDNOCI NA PERINATALNE ISHODE U REPUBLICI HRVATSKOJ--ISKUSTVO JEDNOG CENTRA

Pregnancy can alter the natural course of epilepsy and affect pharmacokinetic profile of antiepileptic drugs (AEDs) making therapeutic management more demanding. Since there is no relevant population-based study in Croatia to date, we conducted this research with the aim to observe antiepileptic treatment policy in pregnancy and to determine if the number of AEDs affects pregnancy outcomes. The study included all women with epilepsy with singleton pregnancy exposed to one or more AEDs divided into two groups (group 1: one AED and group 2: more than one AED used). Data were collected retrospectively at the Department of Obstetrics and Gynecology, Zagreb University Hospital Centre, Zagreb, Croatia, and included 153 women from January 2010 to December 2018. Primary outcomes included rates of preterm delivery, major fetal malformations, gestational hypertension, cesarean section rate, and appearance of seizures during pregnancy. We found higher rates of all pregnancy complications examined than in the general population, while comparison of the two study groups yielded significant differences. Preterm labor was detected in 30% of deliveries in polytherapy group compared to 16.6% in monotherapy group (p=0.03). Gestational hypertension was recorded in 20% of women in polytherapy group vs. 4.90% in monotherapy group (p=0.009). There was also a high rate of cesarean deliveries in polytherapy group (27.5%). Seizures during pregnancy occurred in 48.4% of patients in polytherapy group, which was significantly higher than the rate recorded in monotherapy group (p=0.015). In this single-center retrospective study, women with epilepsy using AEDs during pregnancy had a higher rate of gestational hypertension and preterm delivery than the general population of pregnant women. To the best of our knowledge, this is the first study in Croatia observing antiepileptic treatment policy in pregnancy with regards to AED regimen and perinatal outcome. Key words: Pregnancy; Epilepsy; Antiepileptic drugs; Gestational hypertension; Preterm delivery Trudnoca moze izmijeniti prirodni tijek epilepsije i utjecati na farmakokinetiku antiepileptika (AED), sto dodatno otezava lijecenje. Buduci da do danas u Hrvatskoj ne postoji relevantno populacijsko istrazivanje, proveli smo istrazivanje s ciljem promatranja nacina primjene AED-a u trudnoci i utvrdivanja utjece li broj primijenjenih AED-a na ishode trudnoce. Istrazivanje je obuhvatilo sve zene s epilepsijom i jednoplodnom trudnocom izloze