Abstract
Background and ObjectivesAssess the incidence and factors associated with major depressive episodes (MDEs) and symptoms of depression and anxiety during pregnancy and postpartum periods in pregnant women with epilepsy (PWWE) compared with healthy pregnant women (HPW) and nonpregnant women with epilepsy (NPWWE) in comparable timeframes. Previous studies have reported higher rates of postpartum depression in women with epilepsy compared with women without epilepsy. However, the incidence of MDE using a structured interview during pregnancy and postpartum has not been directly compared with control groups, and the comparison of depression and anxiety symptoms and the role of associated factors remain ambiguous.MethodsThe Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs study is a multicenter NIH-funded prospective observational parallel group cohort study of PWWE and their children. This report examines mood disorders. Unlike previous epilepsy pregnancy studies, the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV (SCID) provided lifetime diagnoses, and repeated SCID mood modules assessed for MDE, the a priori primary outcome. Symptoms of depression (Beck Depression Inventory [BDI] and Edinburg Postnatal Depression Scale [EPDS]) and anxiety (Beck Anxiety Inventory [BAI]) were also assessed along with multiple clinical factors.ResultsThis study included PWWE (n = 331) and HPW (n = 102) during pregnancy and postpartum and NPWWE (n = 102) at comparable times. No difference in SCID-diagnosed MDE incidence was found across groups, but BDI depressive symptoms were worse during pregnancy in PWWE vs NPWWE and during postpartum vs HPW and NPWWE. BAI anxiety symptoms were worse during pregnancy in PWWE vs HPW and NPWWE and during postpartum vs HPW. Factors associated with MDE during pregnancy/postpartum for PWWE included >1 seizure/90 days, anticonvulsant polytherapy, unplanned pregnancy, and lifetime history of mood disorder. Suicidal ideation from BDI or EPDS was related to BAI anxiety symptoms.DiscussionAlthough SCID-based MDE did not differ across groups, this prospective study confirms higher rates of psychiatric symptoms in patients with epilepsy during pregnancy and postpartum, provides new data on associated factors, and underscores the importance of anxiety in risk for depression and thoughts of death/dying or suicide. Given the risks, PWWE should be routinely assessed and symptomatic patients should be offered treatment.Trial Registration InformationThis study is registered at ClinicalTrials.gov as NCT01730170.
| Original language | English (US) |
|---|---|
| Pages (from-to) | E1573-E1583 |
| Journal | Neurology |
| Volume | 99 |
| Issue number | 15 |
| DOIs | |
| State | Published - Oct 11 2022 |
Funding
This study was funded by NIH, National Institute of Neurological Disorders and Stroke/NICHD #U01-NS038455. K.J. Meador has received research support from the NIH, Eisai, and Medtronic Inc. The Epilepsy Study Consortium pays his university for his research consultant time related to Eisai, GW Pharmaceuticals, NeuroPace, Novartis, Supernus, Upsher-Smith Laboratories, UCB Pharma, and Vivus Pharmaceuticals. In addition, K.J. Meador is Co-I and Director of Cognitive Core of the Human Epilepsy Project for the Epilepsy Study Consortium and is on the editorial boards for Neurology, Cognitive & Behavioral Neurology, Epilepsy & Behavior, and Epilepsy & Behavior Case Reports. Z.N. Stowe has received salary and research support from the NIH and CDCP; in the past 36 months has served on the advisory board for Sage Therapeutics; and prior to 2016, received clinical trial support from Janssen Pharmaceuticals and Sage Therapeutics. Prior to 2009, Z.N. Stowe received research support and consultation honorarium from GlaxoSmithKline, Pfizer, and Wyeth Corporations and received speaker honoraria from these companies and Eli Lilly and Forest Corporations. P.E. Voinescu received honoraria for lectures/workshops from Brainwork and Neurodiem. E.E. Gerard has served as site-PI for clinical trials sponsored by Xenon and Sunovion pharmaceuticals. She has also been reimbursed for lectures given to GW Pharmaceuticals Staff and Neurology Week. P. Penovich is on the the speakers bureau for Greenwich Biosciences, advisory board for LVIS, and on both the advisory board and speakers bureau for Neurelis, SK Life Sciences, and UCB Pharma. P.B. Pennell has received research support from the NIH and the Karger Foundation and author royalties from UpToDate, Inc. The other authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.
ASJC Scopus subject areas
- Clinical Neurology
