Evidence map›Paper›PMID 29980637›Full record

ArticleNeurology2018

Anticonvulsants and the risk of perinatal bleeding complications: A pregnancy cohort study.

Alice Panchaud, Jacqueline M Cohen, Elisabetta Patorno, Krista F Huybrechts, Rishi J Desai, Kathryn J Gray, Helen Mogun, Sonia Hernandez-Diaz, Brian T Bateman

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
1.1field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 7 citations in OpenAlex.

  1. Epilepsy in Pregnancy-Management Principles and Focus on Valproate.International journal of molecular sciences · 2022
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 1 institution in 1 country.

Alice PanchaudFrom the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. alice.panchaud@chuv.ch.
Jacqueline M CohenFrom the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
Elisabetta PatornoFrom the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
Krista F HuybrechtsFrom the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
Rishi J DesaiFrom the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
Kathryn J GrayFrom the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
Helen MogunFrom the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
Sonia Hernandez-DiazFrom the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
Brian T BatemanFrom the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
Harvard University · US

Funding

Hormones/Genes in Women's Health: From Bench to BedsideK12HD051959 · NICHD · BRIGHAM AND WOMEN'S HOSPITAL · PI GOLDSTEIN, JILL M, REXRODE, KATHRYN M · 2005 to 2023
$8.8M
Comparative Safety of commonly prescribed Psychotropic Drugs in pregnant WomenR01MH100216 · NIMH · HARVARD SCHOOL OF PUBLIC HEALTH · PI HERNANDEZ-DIAZ, SONIA · 2014 to 2016
$1.4M
NICHD NIH HHS K12 HD051959NIMH NIH HHS R01 MH100216
6 · The paper itself

Abstract

objectiveTo examine the risk of postpartum hemorrhage (PPH) and neonatal bleeding complications associated with late-pregnancy exposure to anticonvulsant drugs (ACDs) that induce cytochrome P450 enzymes (ACDi) and alter the metabolism of vitamin K compared to other ACDs.

methodsWe used a population-based cohort study stemming from a nationwide sample of publicly insured pregnant women with a liveborn infant from the 2000 to 2010 Medicaid Analytic eXtract. ACDi (carbamazepine, phenobarbital, phenytoin, oxcarbazepine, topiramate) were compared to other ACDs dispensed during the last month of pregnancy. Relative risks (RRs) and 95% confidence intervals (CIs) of PPH and neonatal bleeding complications were estimated using generalized linear models with fine stratification on the propensity score to control for indication and other potential confounders.

resultsAmong 11,572 women with an ACD prescription overlapping delivery, 2.6% (135/5,109) in the ACDi group and 3.6% (231/6,463) in the other ACDs group had a diagnosis of PPH: unadjusted RR 0.74 (95% CI 0.60-0.91), adjusted RR 0.77 (95% CI 0.58-1.00). The prevalence of neonatal bleeding complications was 3.1% (157/5,109) in the ACDi group and 3.5% (229/6,463) in the other ACDs group: unadjusted RR 0.87 (95% CI 0.71-1.06), adjusted RR 0.83 (95% CI 0.64-1.08).

conclusionsEvidence from this large observational study suggests that use of ACDi near delivery does not increase the risk of bleeding complications compared to other ACDs in clinical settings where neonatal intramuscular or oral vitamin K administration is considered standard of care. These findings provide reassurance for clinicians and pregnant women successfully treated with ACDi.

Indexed as

MedicaidAdolescentAdultAnticonvulsantsCohort StudiesFemaleHumansInfant, NewbornPostpartum HemorrhagePregnancyPregnancy ComplicationsRisk FactorsUnited StatesYoung AdultAnticonvulsants

Identifiers

PMID29980637
PMCPMC6105051
OpenAlexW2826290231

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.