Effects of epilepsy and antiepileptic drugs on fetal cardiac functions: A cross‐sectional study from a tertiary center

Aim This study aimed to assess fetal cardiac function in response to epilepsy and antiepileptic drugs. Methods This cross‐sectional prospective study included 31 pregnant women with epilepsy (22 on monotherapy, 9 unmedicated) and 45 randomly selected, gestational age‐matched low‐risk pregnant women. The mean gestational ages were comparable across groups: 30.27 ± 2.95 weeks for the monotherapy group, 30.11 ± 2.80 weeks for the unmedicated epilepsy group, and 31.13 ± 2.83 weeks for the control group ( p = 0.397). Fetal cardiac function was evaluated using indices of systolic and diastolic function: isovolumetric contraction time, isovolumetric relaxation time (IRT), ejection time, myocardial performance index (MPI), mitral and tricuspid maximum early ventricular filling ( E ) wave velocity, maximum active atrial filling ( A ) wave velocity, E / A ratios, mitral and tricuspid annular plane systolic excursion, and pulmonary and aortic artery peak velocities. Results In the monotherapy epilepsy group, IRT was significantly prolonged (47.77 vs. 42.78 vs. 43.47, p = 0.006 and p < 0.001), and MPI was significantly increased (0.49 vs. 0.46 vs. 0.46, p = 0.027 and p = 0.194) compared to the unmedicated epilepsy and control groups. Tricuspid valve E values were significantly lower in the monotherapy epilepsy group (40.49 vs. 43.87, p = 0.034). Furthermore, IRT values were prolonged in the subgroup with seizures during pregnancy compared to those without (40.73 vs. 44.45, p = 0.001). Conclusion To our knowledge, this was the first study to examine the potential cardiac functional impact of epilepsy and antiepileptic drugs. This study demonstrated a small but significant association between maternal antiepileptic drug use and impaired fetal cardiac diastolic function, as assessed by ultrasound.