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Infertility more common in women with epilepsy

(Reuters Health) - Women with epilepsy may have a higher-than-average risk of fertility problems,
particularly those on multiple anti-seizure drugs, a study published Monday suggests.
Researchers in India found that among 375 women with epilepsy who were trying to become pregnant, 62
percent successfully conceived, usually within two years. The rest, 38 percent, remained infertile over an
average of three years of follow-up.
That compared with an infertility rate of 15 percent among married women in the surrounding Indian state of
Kerala, according to the researchers.
The findings, reported in the journal Neurology, strengthen the evidence that women with epilepsy have a
higher-than-average risk of fertility problems. They also indicate that women taking multiple anti-epilepsy
drugs may be particularly at risk.
Of women on just one medication, 32 percent failed to conceive during the study period. That figure was 41
percent among women on two epilepsy drugs, and 60 percent among those on three or more drugs. Only 7
percent of those not taking any anti-seizure medication failed to conceive during the study.
The results do not prove, however, that the drugs themselves are to blame, or at least fully to blame.
Since women on multiple epilepsy drugs are likely to have more severe epilepsy, it's possible that the
severity of the disorder plays a role, according to Dr. Alison M. Pack, a neurologist at Columbia University
Medical Center in New York and author of an editorial published with the study.
Whatever the reasons for the association, Pack told Reuters Health, "This suggests that women with epilepsy
should be advised that they may have a higher-than-average risk of infertility."
She suggested that women who are planning a pregnancy talk with their doctors; if possible, those on
multiple epilepsy drugs may want to trim their drug regimen down.
Guidelines from the American Academy of Neurology and American Epilepsy Society already suggest that
during pregnancy, women take only one anti-seizure medication whenever possible to lower the chances of
birth defects.
In particular, women are advised to avoid the older epilepsy drug valproate (Depakene, Epival) during
pregnancy; two other older medications -- phenobarbital (Luminal) and phenytoin (Dilantin) -- should also
be limited.
It is not clear which drugs in particular may be related to fertility problems. In the current study,
phenobarbital was the only individual drug associated with an increased infertility risk.
Phenobarbital and some other older epilepsy medications, like carbamazepine (Carbatrol, Tegretol), induce
liver enzymes that affect blood levels of estrogen and other reproductive hormones. So it's possible that they
could affect a woman's ability to become pregnant, said Pack, who is also a consultant to Pfizer, Inc., maker
of the epilepsy drug Neurontin (gabapentin).
She noted that too few women were on any of the newer drugs commonly used in developed countries for
the researchers to assess their association with fertility. Those include medications like topiramate
(Topamax), levetiracetam (Keppra), lamotrigine (Lamictal) and oxcarbazepine (Trileptal).
More research is still needed into how the various epilepsy drugs might affect fertility, Dr. Sanjeev V.
Thomas, the senior researcher on the study, told Reuters Health in an e-mail.

But studies investigating the effects of prenatal arsenic exposure have had mixed results.reuters. The investigators also didn't see a dose-response relationship. they note.Babies born to mothers with high levels of arsenic exposure are five times more likely to die before their first birthday than infants whose mothers had the least exposure to the toxic mineral.prenatal arsenic exposure quintuples infant death risk NEW YORK | Thu Oct 7. this relationship was relatively weak and could have been due to chance.253 micrograms per liter. Rahman and colleagues say. meaning the risk of miscarriage didn't rise steadily as exposure increased. new research shows.924 pregnant women who provided urine samples for arsenic testing. Anisur Rahman of Uppsala University Hospital in Sweden and colleagues state in the November issue of Epidemiology. those in the top fifth for arsenic exposure were five times as likely to see their infant die before his or her first birthday compared with those in the bottom fifth.. Public health experts estimate that as many as 77 million people in Bangladesh have been poisoned by arsenic in drinking water. 2010 3:15pm EDT NEW YORK (Reuters Health) . and two percent had stillborn babies." The study was conducted in Bangladesh. The infants died of a range of causes. Arsenic causes cancer. In the U.com/faq47p Epidemiology. "is supportive of a causal relationship.S. those in the bottom fifth had concentrations below 33 micrograms per liter. where millions of tube wells dug 30 years ago to improve the country's water supply are now known to be contaminated with naturally occurring arsenic. including infections and impaired growth. and some later in pregnancy. To address these issues. November 2010 . high blood pressure. using different types of wells. and harvesting rainwater. Nor was a clear association between arsenic exposure and risk of stillbirth seen in the group. Women in the top fifth based on their arsenic exposure had urine concentrations that ranged from 249 to 1. and many other chronic illnesses. Many previous studies were retrospective. urine arsenic levels between zero and 35 micrograms per liter are considered normal. and the researchers say more study is needed to understand exactly how a mother's arsenic exposure may contribute to the baby's risk of a premature death. "We observed clear evidence of an association between arsenic exposure and infant mortality. the researchers followed 2." Dr. however. while about four percent of these babies died before they were 12 months old. About nine percent of the women miscarried. meaning researchers asked women about pregnancy outcomes after the fact and their responses are therefore less reliable. three percent had abortions. they add. the researchers explain. SOURCE: link. And the fact that death risk increased as exposure rose. The most heavily exposed women in the study were 40 percent more likely to miscarry than those with the lowest exposure. But the researchers did find a strong dose-response relationship between arsenic exposure and infant mortality risk. and has also been linked to diabetes. potential approaches to reducing exposure include filtering water through pond sand. Most studies have also measured the amount of arsenic found in local drinking water but have not looked at how much water women actually consumed during pregnancy. Among the women who gave birth to a live baby. all when they were eight weeks pregnant. the researchers say. Eighty-six percent of the women had live births.

according to Maslova and her colleagues. most of the studies included mainly white women..about the amount in two 8-ounce cups of coffee -. They point out that most of the research they analyzed did not measure caffeine intake beyond 400 mg per day.S. Further assessing the effects of higher total caffeine intakes. Genetic differences in how individuals metabolize caffeine could also. so it is not clear whether higher intakes might affect preterm delivery risk. Earlier this year.occurring before the 37th week of gestation . Nor did they find any link between the amount of coffee the women drank and their odds of an early delivery. tea and other caffeine sources and their odds of preterm birth. In addition. according to the researchers. ACOG notes. excess caffeine could make pregnancy tougher by interfering with a woman's sleep or contributing to nausea and light-headedness. pregnant women may want to err on the side of caution and limit their intake. Still. Whether higher caffeine intake might boost those odds remains unclear. had no higher risk of preterm birth than women who consumed little to no caffeine." they conclude. Some research.such as enhanced bottled waters. Individually. The latest findings do not mean that caffeine is entirely "safe" for pregnant women. and 7 percent of births in Europe are pre-term -. in theory. energy drinks and herbal supplements. Canada. In addition.and low birth weight. above 400 mg a day. But they do support the conclusion that.according to the authors.roughly equivalent to three to four cups of coffee per day -. It can also boost urination and lead to dehydration.A new analysis adds to evidence that pregnant women can have a morning cup of coffee without fearing they will raise their risk of preterm delivery.000 women. online September 15. when the researchers combined the data from all the studies. 2010 4:16pm EDT (Reuters Health) . the American College of Obstetricians and Gynecologists (ACOG) issued a statement saying that pregnant women who consume up to 200 milligrams (mg) of caffeine per day -.reuters. at least in moderate amounts. the researchers note. will be "especially important. Europe and Brazil looking at the relationship between pregnant women's reported intake of coffee. However. . Similarly. for example. whose report appears in the American Journal of Clinical Nutrition. they found that women who reported having 300 mg of caffeine or more each day. influence any effects of caffeine on pregnancy. Combining the results of 22 previous studies. according to Maslova's team. researchers found no evidence that pregnant women who downed the most caffeine -. the results leave open some questions. according to ACOG.with eight showing either an increased or a decreased risk of preterm delivery among women who consumed higher levels of caffeine during pregnancy.had a higher risk of preterm birth than women who avoided caffeine throughout pregnancy. it does not contribute to preterm births. The two largest studies each included more than 40. Their analysis included 22 studies from the U.even as little as 100 mg per day -. Caffeine may not up preterm birth risk NEW YORK | Tue Sep 28.S.are unlikely to raise their odds of miscarriage or preterm delivery. the studies differed considerably in their conclusions -.com/puf85p American Journal of Clinical Nutrition. whose caffeine content is often not recognized. 2010. Approximately 12 percent of births in the U. SOURCE: link. Although such studies do not prove that caffeine is the cause. The rest showed no clear connection between caffeine and preterm birth. has found an association between maternal caffeine intake -. led by Ekaterina Maslova of the Harvard School of Public Health. Maslova and her colleagues say there is still a need for studies examining more diverse groups of women to see whether there are any ethnic differences in the relationship between caffeine and preterm birth. the group also cautions that there are other reasons pregnant women may opt to avoid caffeine. during any trimester. in light of new caffeine sources beyond coffee and tea -.

Yet only about 14% of new mothers in the US managed to follow the American Academy of Pediatrics' recommendation to exclusively breastfeed their infants for the first 6 months. "They should talk to their doctor about what steps they can take to modify their own risk of developing diabetes. legislators and employers. SOURCE: link. They compared the incidence of type 2 diabetes in 2.5 percent) of women who never had children. is not known. The authors urge "ongoing support of breastfeeding" from doctors. Animal studies have shown that the formation and secretion of milk by the mammary glands (lactation) may itself start biological processes that increase sensitivity to insulin and reduce the formation of belly fat. for whatever reason.com/fas72p The American Journal of Medicine. Schwarz said. In type 2 diabetes. To see how long a new mom needs to breastfeed to reap later benefits to her health. The authors also have a message for moms who. because it seems they are probably at higher risk than other women in the community. Why this is so. Previous research demonstrated health benefits to moms who breastfed as long as six months or a year.Mothers who don't breastfeed their newborns for at least one month are more likely to develop type 2 diabetes at some point in their lives than women who do. told Reuters Health. either the body does not produce enough insulin or the cells ignore the insulin that the body needs to turn food into energy.7 percent) of the study mothers who didn't breastfeed their infants later went on to develop diabetes compared to 202 (18 percent) of women who exclusively breastfed their newborn at least one month and 71 (17.125 women). Eleanor Schwarz of the University of Pittsburgh. lasting effects. Dr.233 women between the ages of 40 and 78. The findings "highlight the importance to maternal health of consistent lactation after each birth" and add to the growing body of evidence that not breastfeeding might add to health risks. . divided into three groups: those who had never had children (405 women). a Pennsylvania study finds. September 2010. "Breastfeeding is part of the normal recovery process" from pregnancy and giving birth. The Pennsylvania results suggest that even a month of breastfeeding can have positive." the lead author. The researchers found that 188 (26. 2010 1:29pm EDT (Reuters Health) . those who had children but never breastfed them (703 women) and those who had breastfed (1. Schwarz and colleagues analyzed a large database of patients treated by Kaiser Permanente Medical Care Program of Northern California. Schwarz said.reuters." Schwarz said. An estimated 10 percent of American women have it. The study results tell new mothers that they can do something for their own health by breastfeeding for at least a month. "Women who give birth but do not breastfeed face an increased risk of developing type 2 diabetes." the authors conclude in the September 9 issue of the American Journal of Medicine. Breastfeeding for a month cuts mom's diabetes risk By Rachael Myers Lowe NEW YORK | Fri Sep 10. they point out. never breastfed their children. the most common form of the disease. "What we found that was somewhat surprising was the pretty dramatic benefits for moms who breastfed as short as a month after the birth of their child.