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Abstract
Background and Objectives Assess 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.
Methods The 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.
Results This 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.
Discussion Although 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 Information This study is registered at ClinicalTrials.gov as NCT01730170.
Glossary
- ASM=
- antiseizure medication;
- BAI=
- Beck Anxiety Inventory;
- BDI=
- Beck Depression Inventory;
- EPDS=
- Edinburg Postnatal Depression Scale;
- HPW=
- healthy pregnant women;
- MDE=
- major depressive episode;
- MONEAD=
- Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs;
- NPWWE=
- nonpregnant women with epilepsy;
- OR=
- odds ratio;
- PWWE=
- pregnant women with epilepsy;
- SCID=
- Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV;
- WWE=
- women with epilepsy
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work (co-first authors).
MONEAD Investigator Group coinvestigators are listed at links.lww.com/WNL/C235.
Submitted and externally peer reviewed. The handling editor was Barbara Jobst, MD, PhD, FAAN.
Editorial, page 637
CME Course: NPub.org/cmelist
- Received December 13, 2021.
- Accepted in final form May 25, 2022.
- © 2022 American Academy of Neurology
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