Sex-Specific Patterns of Reproduction in People With Epilepsy: A Nationwide Cohort Study From Denmark.

IF 8.5 1区医学 Q1 CLINICAL NEUROLOGY Neurology Pub Date : 2025-04-08 Epub Date: 2025-03-17 DOI:10.1212/WNL.0000000000213468

Josefine Klakk, Betina B Trabjerg, Samuel F Berkovic, Chris Cotsapas, Churl-Su Kwon, Ruth Ottman, Julie Werenberg Dreier, Jakob Christensen

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Abstract

Background and objectives: Reproduction is lower in male individuals compared with female individuals with epilepsy. The reason is unknown. We studied sex-specific reproduction in individuals with epilepsy and the role of epilepsy subtype and psychiatric comorbidity.

Methods: We conducted a population-based register study in Denmark, using data from January 1, 1982, to December 31, 2021. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHRs) with 95% CIs for the chance of having ≥1 child. We followed all persons from 15 years of age until birth of live-born offspring, 45 years of age, emigration, death, or end of follow-up (December 31, 2021), whichever occurred first. Epilepsy status was identified from the Danish National Patient Register. The primary outcome was the occurrence of live-born children identified from the Danish Medical Birth Register among persons with and without epilepsy.

Results: We included 2,593,097 individuals (49% of female individuals), including 46,243 (1.8%) with epilepsy (mean age at diagnosis of 13.1 years [SD 9.2]). Compared with individuals without epilepsy, the aHR of having ≥1 child was reduced in both sexes with epilepsy, but lower in male individuals (0.59, 95% CI 0.57-0.60) compared with female individuals with epilepsy (0.72, 95% CI 0.71-0.74). By age 45 years, the probability of being childless was 45.9% in male individuals and 30.7% in female individuals with epilepsy, compared with 22.8% in male individuals and 14.1% in female individuals without epilepsy. Compared with persons without epilepsy, the chance of having a first child was lower in female individuals with focal epilepsy (aHR 0.61, 95% CI 0.58-0.64) than in female individuals with generalized epilepsy (aHR 0.72, 95% CI 0.69-0.75), and lower in male individuals with focal epilepsy (aHR 0.51, 95% CI 0.48-0.53) than in male individuals with generalized epilepsy (aHR 0.57, 95% CI 0.54-0.60). Reproduction was particularly low in persons with epilepsy and psychiatric comorbidity (male individuals: aHR 0.30, 95% CI 0.28-0.32; female individuals: aHR 0.51, 95% CI 0.48-0.53).

Discussion: Individuals with epilepsy were less likely to become parents than individuals without epilepsy, and the association was stronger in male individuals and those with psychiatric comorbidity and varied with epilepsy subtype.

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癫痫患者的性别特异性生殖模式：丹麦全国队列研究》。

背景和目的：与女性癫痫患者相比，男性癫痫患者的生殖能力较低。原因尚不清楚。我们研究了癫痫患者的性别特异性生殖以及癫痫亚型和精神合并症的作用。方法：我们在丹麦进行了一项基于人群的登记研究，使用了1982年1月1日至2021年12月31日的数据。Cox比例风险模型用于估计有≥1个孩子的机会的校正风险比（aHRs）， ci为95%。我们对所有人进行随访，从15岁到活产后代出生、45岁、移民、死亡或随访结束（2021年12月31日），以先发生者为准。癫痫状态从丹麦国家患者登记册中确定。主要结果是从丹麦医疗出生登记册中确定的癫痫患者和非癫痫患者的活产儿童发生率。结果：我们纳入了2,593,097例（占女性个体的49%），包括46,243例（1.8%）癫痫患者（诊断时平均年龄为13.1岁[SD 9.2]）。与无癫痫患者相比，有≥1个孩子的癫痫患者男女aHR均降低，但男性患者aHR （0.59, 95% CI 0.57-0.60）低于女性患者aHR （0.72, 95% CI 0.71-0.74）。到45岁时，男性癫痫患者无子女的概率为45.9%，女性癫痫患者为30.7%，而男性无癫痫患者为22.8%，女性无癫痫患者为14.1%。与无癫痫患者相比，女性局灶性癫痫患者（aHR 0.61, 95% CI 0.58-0.64）比女性全身性癫痫患者（aHR 0.72, 95% CI 0.69-0.75）生育第一个孩子的机会更低，男性局灶性癫痫患者（aHR 0.51, 95% CI 0.48-0.53）比男性全身性癫痫患者（aHR 0.57, 95% CI 0.54-0.60）更低。患有癫痫和精神疾病的人的生殖能力特别低(男性个体：aHR 0.30, 95% CI 0.28-0.32；女性个体：aHR 0.51, 95% CI 0.48-0.53)。讨论：癫痫患者成为父母的可能性低于非癫痫患者，这种关联在男性和精神疾病患者中更强，且随癫痫亚型的不同而不同。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology 医学-临床神经学

CiteScore

12.20

自引率

4.00%

发文量

1973

审稿时长

2-3 weeks

期刊介绍： Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology. As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content. Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.