Abstract Details

Title Sex Steroid Hormone Serum Concentrations in Pregnant Women with Epilepsy in MONEAD

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S19 - Epilepsy Clinical Trials and Long-term Studies (4:30 PM-4:42 PM)

Poster/Presentation
Number 006

Background

SSH concentrations dramatically increase throughout pregnancy. They and their neuroactive steroid metabolites may influence fetal neurodevelopment and seizure control in PWWE. EIASMs alter SSH concentrations in the non-pregnant state. This secondary analysis aims to evaluate this effect in PWWE.

Objective Compare sex steroid hormone (SSH) serum concentrations in pregnant women with epilepsy (PWWE) on enzyme-inducing (EI) antiseizure medications (ASMs) to PWWE on non-EIASMs or no ASM.

Design/Methods

Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) is a prospective, observational, multi-center study of PWWE, enrolled <20 weeks gestation. Serum progesterone, estradiol, and estrone concentrations were measured at enrollment, trimesters two and three and delivery. Some participants had multiple samples in the second and/or third trimesters. Participants were categorized into the EIASM group if on at least one EIASM (carbamazepine, oxcarbazepine, topiramate, felbamate, phenobarbital, phenytoin, clobazam, perampanel) or non-EIASM group if not using any EIASM. We compared demographics with chi-squared and independent T-tests and calculated SSH distributions.

Results Samples were available in 30 PWWE on EIASMs and 169 PWWE on non-EIASM regimens (1st trimester n=10, 52; 2nd trimester n=37, 240; 3rd trimester n=30, 188; delivery n=8, 39, respectively). There were no differences between groups for race/ethnicity, marital status, income, IQ, but EIASM users were less educated and younger (mean: 28.0 years (95%CI: 26.1, 29.9) vs. 31.3 (30.5, 32.0). Progesterone and estradiol concentrations did not appear different between groups at any pregnancy stage. Estrone concentrations for the EIASM group appeared consistently lower, most notably in the second [median: 1572pg/mL (IQR: 621, 2690) vs 3030 (1820, 5040)] and third trimesters [3025 (1460, 4510) vs 5095 (3605, 7025)].

Conclusions

EIASM regimens in PWWE did not notably affect progesterone and estradiol concentrations. However, estrone concentrations were lower in the second and third trimesters. Future studies will include investigation of potential implications for maternal and child outcomes.

Authors/Disclosures
Paula E. Voinescu, MD (Brigham and Women'S Hospital) PRESENTER	The institution of Dr. Voinescu has received research support from Epilepsy Foundation of New England. The institution of Dr. Voinescu has received research support from BWH - Connors Center. The institution of an immediate family member of Dr. Voinescu has received research support from American Epilepsy Society. Dr. Voinescu has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Physicians' Education Resouce. Dr. Voinescu has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Phillipines League Against Epilepsy. Dr. Voinescu has a non-compensated relationship as a Board Member and Chair with My Epilepsy Story that is relevant to AAN interests or activities. Dr. Voinescu has a non-compensated relationship as a Speaker with Epilepsy Foundation that is relevant to AAN interests or activities. Dr. Voinescu has a non-compensated relationship as a Grant Reviewer with Epilepsy Ireland that is relevant to AAN interests or activities. Dr. Voinescu has a non-compensated relationship as a Grant Reviewer with American Epilepsy Society that is relevant to AAN interests or activities. Dr. Voinescu has a non-compensated relationship as a Member of Scientific Advisory Committee with North American AED Pregnancy Registry that is relevant to AAN interests or activities.
Page B. Pennell, MD, FAAN (University of Pittsburgh School of Medicine)	The institution of Dr. Pennell has received research support from NIH. The institution of an immediate family member of Dr. Pennell has received research support from Department of Defense. The institution of an immediate family member of Dr. Pennell has received research support from Environmental Protection Agency. The institution of an immediate family member of Dr. Pennell has received research support from NIH. The institution of an immediate family member of Dr. Pennell has received research support from Advanced Energy Consortium. Dr. Pennell has received publishing royalties from a publication relating to health care.
Alison M. Pack, MD, FAAN (Neurological Institute, Columbia University)	An immediate family member of Dr. Pack has received personal compensation for serving as an employee of REGENEXBIO. The institution of Dr. Pack has received research support from National Institutes of Health. Dr. Pack has received publishing royalties from a publication relating to health care.
Elizabeth Gerard, MD (Northwestern University)	Dr. Gerard has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Greenwich Pharmaceuticals. The institution of Dr. Gerard has received research support from NIH/NINDS. The institution of Dr. Gerard has received research support from Xenon Pharmaceuticals. The institution of an immediate family member of Dr. Gerard has received research support from NIH. The institution of an immediate family member of Dr. Gerard has received research support from Novo Nordisk. The institution of Dr. Gerard has received research support from Eisai, Inc. (via Stanford University).
Laura A. Kalayjian, MD (University of Southern California)	The institution of Dr. Kalayjian has received research support from NIH.
Angela K. Birnbaum, PhD (University of Minnesota)	The institution of Dr. Birnbaum has received research support from National Institutes of Health. The institution of Dr. Birnbaum has received research support from Randy Shaver Cancer and Research Foundation. Dr. Birnbaum has received intellectual property interests from a discovery or technology relating to health care.
Carrie Brown (Emmes)	No disclosure on file
Alice Henning (Emmes)	No disclosure on file
Kimford J. Meador, MD, FAAN (Stanford University School of Medicine)	The institution of Dr. Meador has received research support from NIH. The institution of Dr. Meador has received research support from Eisai. The institution of Dr. Meador has received research support from Medtronics. The institution of Dr. Meador has received research support from The Epilepsy Consortium.