Epileptic Women Face Increased Complications During Delivery

A new study suggests that pregnant women with epilepsy have a higher risk of morbidity and mortality during delivery.

Researchers at Harvard School of Public Health (HSPH; Boston, MA, USA), Massachusetts General Hospital (MGH; Boston, MA, USA), and other institutions conducted a retrospective cohort study of pregnant women identified from the 2007–2011 US Nationwide Inpatient Sample, obtaining a weighted sample of subsequent deliveries by 69,385 women with epilepsy, and 20,449,532 women without. Main outcomes of the study included maternal death, cesarean delivery, length of stay, preeclampsia, preterm labor, and stillbirth.

The results showed that women with epilepsy had a risk of death during delivery hospitalization of 80 deaths per 100,000 pregnancies, more than 12-fold higher than the six deaths per 100,000 pregnancies found among women without epilepsy. Women with epilepsy were also at a heightened risk for other adverse outcomes, including preeclampsia, preterm labor, and stillbirth, as well as increased healthcare utilization, increased risk of cesarean delivery, and prolonged length of hospital stay. The study was published on July 6, 2015, in JAMA Neurology.

“Women with epilepsy are at considerably heightened risk for many adverse outcomes during their delivery hospitalization, including a more than 10-fold increased risk of death,” concluded lead author Sarah MacDonald, BSc, of HSPS, and colleagues. “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.”

The clinical management of pregnancies among women with epilepsy involves consistent monitoring of antiepileptic drug levels, along with corresponding adjustments in dosage, to prevent seizures up to delivery. At the same time, the antiepileptic drugs themselves pose a risk of birth defects, such as oral clefts and neural tube defects, which are more common after in utero exposure. Between 0.3% and 0.5% of all pregnancies occur among women with epilepsy.

Related Links:
Harvard School of Public Health
Massachusetts General Hospital