Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. 1298-1306 (doi:10.1542/peds.2005-1660)
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Relation of Pregnancy and Neonatal Factors to Subsequent Development of Childhood Epilepsy: A Population-Based Cohort Study

Elizabeth Whitehead, MSca, Linda Dodds, PhDb, K.S. Joseph, MD, PhDb, Kevin E. Gordon, MD, MSc, Ellen Wood, MD, MScc, Alexander C. Allen, MDb, Peter Camfield, MDc and Joseph M. Dooley, MBc

a Department of Community Health and Epidemiology
b Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynaecology and Pediatrics
c Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada

OBJECTIVE. We examined the effect of pregnancy and neonatal factors on the subsequent development of childhood epilepsy in a population-based cohort study.

PATIENTS AND METHODS. Children born between January 1986 and December 2000 in Nova Scotia, Canada were followed up to December 2001. Data on pregnancy and neonatal events and on diagnoses of childhood epilepsy were obtained through record linkage of 2 population-based databases: the Nova Scotia Atlee Perinatal Database and the Canadian Epilepsy Database and Registry. Factors analyzed included events during the prenatal, labor and delivery, and neonatal time periods. Cox proportional hazards regression models were used to estimate relative risks and 95% confidence intervals.

RESULTS. There were 648 new cases of epilepsy diagnosed among 124207 live births, for an overall rate of 63 per 100000 person-years. Incidence rates were highest among children <1 year of age. In adjusted analyses, factors significantly associated with an increased risk of epilepsy included eclampsia, neonatal seizures, central nervous system (CNS) anomalies, placental abruption, major non-CNS anomalies, neonatal metabolic disorders, neonatal CNS diseases, previous low birth weight infant, infection in pregnancy, small for gestational age, unmarried, and not breastfeeding infant at the time of discharge from hospital.

CONCLUSIONS. Our study supports the concept that prenatal factors contribute to the occurrence of subsequent childhood epilepsy.

Key Words: epilepsy • prenatal • pregnancy • neonatal • childhood • epidemiology • cohort

Abbreviations: RR—relative risk • CI—confidence interval • CNS—central nervous system • CEDaR—Canadian Epilepsy Database and Registry • EEG—electroencephalography

Accepted Sep 29, 2005.


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