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Adverse pregnancy outcomes far more likely in epilepsy

Close clinical attention crucial for pregnancies in women with epilepsy – though most are normal

Louise Prime

Thursday, 09 July 2015

Women with epilepsy are at considerably heightened risk for many adverse outcomes during hospitalisation for labour and delivery, including a more than 10-fold increased risk of maternal death, according to new research. Authors of the study, published in JAMA Neurology, insist that increased clinical attention is ‘imperative’ for these pregnancies – although most women with epilepsy have uncomplicated pregnancies.

Researchers used hospital records to compare obstetric outcomes – including maternal death, caesarean delivery, length of stay, preeclampsia, preterm labour, and stillbirth – among 69,385 women with epilepsy, with outcomes among 20,449,532 women without epilepsy. They found that women with epilepsy had a risk of death during delivery of 80 per 100,000 pregnancies, compared with just 6 per 100,000 for women without epilepsy.

Compared with women without epilepsy, those with epilepsy had a raised risk of other adverse pregnancy outcomes including preeclampsia (adjusted odds ratio 1.59), preterm labour (OR 1.54) and stillbirth (OR 1.27). They also had increased health care utilisation, including an increased risk of caesarean delivery (OR 1.40) and prolonged hospital stay (>6 days) regardless of delivery method (OR 2.13 for caesarean deliveries and 2.60 for vaginal deliveries).

The study authors pointed out that even for women with epilepsy, the absolute risk of dying during delivery remained very low. But they said: “Regardless of the specific cause, the point that women recorded as having epilepsy have an increased risk of mortality remains a clinically relevant message suggesting that increased attention should be paid. Future research is needed to determine the specific causes of mortality and how interventions might improve outcomes.”

The authors of a linked editorial** commented: “[This] study provides important new information and demonstrates several risks associated with pregnancy in WWE [women with epilepsy]. However, it raises far more questions than it answers. Most WWE have uncomplicated pregnancies. We need to understand the mechanisms underlying these risks, including death, so that we can identify the specific population at risk and devise interventions to reduce these risks. Future studies need to confirm and build on the present findings to improve the care of WWE during pregnancy.”

* MacDonald SC, Bateman BT et al. Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States. JAMA Neurol. July 06, 2015. doi:10.1001/jamaneurol.2015.1017.

** French JA, Meador K. Risks of Epilepsy during pregnancy: how much do we really know? JAMA Neurol. July 06, 2015. doi:10.1001/jamaneurol.2015.1356.

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