To assess the role of antiseizure medication (ASM) regimens and other factors in relation to the occurrence of intrauterine foetal death (IUFD) in pregnant women with epilepsy (WWE) enrolled in the Raoul Wallenberg Australian Pregnancy Register of Antiepileptic Drugs (APR). IUFDs occurred in 70 (3.01 %) of 2,323 prospective pregnancies from WWE with known outcomes in the APR. Factors associated with IUFD occurrence included older maternal age, enrolment in the APR at an earlier stage of pregnancy, history of pregnancies which did not result in livebirths, parental history of foetal malformations, and maternal use of carbamazepine, lamotrigine or ethosuximide. Individual ASM dosages were not associated with IUFD occurrence. Relative to no exposure, the risk of IUFD increased with the increasing number of ASMs used in combination (2 ASMs: relative risk, RR = 5.45 [95 % CI: 0.73–41.80]; 3 ASMs: RR = 10.70 [95 % CI: 1.27–90.17]), >3 ASMs: RR = 10.70 [95 % CI: 1.27–90.17]), but this finding was attenuated after adjusting for other factors implicated in IUFD occurrence. Several ASM pairs were associated with an increased risk of IUFD relative to no exposure, but these associations were lost after accounting for confounders. Although it is possible that prenatal ASM exposure may increase the risk of IUFD, other non-pharmacological factors are more relevant to the occurrence to IUFD in pregnant WWE.

中文翻译：

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怀孕、抗癫痫药物和不明原因的宫内胎儿死亡

旨在评估抗癫痫药物 (ASM) 治疗方案和其他因素与登记在 Raoul Wallenberg 澳大利亚抗癫痫药物妊娠登记册 (APR) 的癫痫孕妇 (WWE) 发生宫内胎儿死亡 (IUFD) 相关的作用。在 WWE 的 2,323 名预期怀孕中，有 70 名 (3.01%) 发生了 IUFD，且 APR 中结果已知。与 IUFD 发生相关的因素包括孕产妇年龄较大、妊娠早期加入 APR、未导致活产的妊娠史、胎儿畸形父母史以及母亲使用卡马西平、拉莫三嗪或乙舒酰。个体 ASM 剂量与 IUFD 的发生无关。相对于没有暴露，IUFD 的风险随着组合使用的 ASM 数量的增加而增加（2 个 ASM：相对风险，RR = 5.45 [95 % CI：0.73–41.80]；3 个 ASM：RR = 10.70 [95 % CI： 1.27–90.17]），>3 ASM：RR = 10.70 [95% CI：1.27–90.17]），但在调整与 IUFD 发生有关的其他因素后，这一发现被减弱。相对于未暴露的情况，几个 ASM 对与 IUFD 风险增加相关，但在考虑混杂因素后，这些关联消失了。尽管产前接触 ASM 可能会增加 IUFD 的风险，但其他非药物因素与妊娠 WWE 中 IUFD 的发生更相关。