FROM JAMA NEUROLOGY
Pregnant women with a history of epilepsy are at increased risk for death and complications during delivery, according to a new study.
It is estimated that women with a history of epilepsy comprise 0.3%-0.5% of all pregnancies, but there are limited data on the risk of death and complications in the pregnant epileptic patient, Sarah MacDonald of Harvard T.H. Chan School of Public Health, Boston, and her colleagues wrote in their paper published online July 6 in JAMA Neurology.
Ms. MacDonald and her associates sought to determine if patients with a history of epilepsy are at increased risk for morbidity and mortality during delivery by conducting a retrospective cohort study of a weighted sample of 20,449,532 women without and 69,385 women with epilepsy in the Nationwide Inpatient Sample from 2007 to 2011. They obtained epilepsy diagnoses and baseline characteristics from ICD-9-CM codes. To limit the possibility of nonepileptic or eclampsia seizures being recorded as epilepsy, patients in the cohort were restricted to those without a history of hypertensive disorders and the ICD-9-CM code for “epilepsy, unspecified” was removed (JAMA Neurol. 2015 July 6 [doi:10.1001/jamaneurol.2015.1017]).
Patients with a history of epilepsy had a frequency of death of 80 per 100,000 pregnancies, versus 6 deaths per 100,000 pregnancies without a history of epilepsy. The researchers noted a greater than 10-fold higher odds of death for epileptic patients (adjusted odds ratio, 11.46; 95% confidence interval, 8.64-15.19) when accounting for age, income, location, year, and race.
Pregnant women with a history of epilepsy were found to have higher rates of labor induction, cesarean section delivery, longer hospital stays, pregnancy-related hypertension, preeclampsia, and hemorrhage. Likewise, the researchers noted increased rates of gestational diabetes, premature rupture of membranes, chorioamnionitis, and premature delivery in patients with epilepsy. Furthermore, the newborns of epileptic mothers had higher rates of stillbirth, fetal distress, and poor growth. Overall, pregnant women with a history of epilepsy had significantly greater odds of severe morbidity (adjusted OR, 2.53; 95% CI, 2.44-2.63).
“However, despite their heightened risk of complications, we did not observe evidence that women with epilepsy are routinely triaged to high-risk medical centers,” the authors noted. But even though “the risk is substantially heightened on the multiplicative scale,” they said that the absolute rate of maternal death during delivery “is still very rare even among women with epilepsy.”
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