Maternal morbidity and mortality associated with epilepsy

Abstract

Objective

Prior research demonstrated large increased risk for maternal mortality among women with epilepsy. The objective of this study was to estimate risk for adverse maternal outcomes during delivery hospitalizations among women with epilepsy.

Methods

Truven Health MarketScan databases were used to compare risk for adverse maternal outcomes during delivery hospitalizations based upon whether there was diagnosis of epilepsy and receipt of anti-epileptic drugs prior to delivery. Outcomes included: (i) death during delivery hospitalization, (ii) severe maternal morbidity, (iii) cesarean delivery, (iv) postpartum hemorrhage, (v) placental abruption, (vi) preeclampsia, (vii) preterm delivery, (viii) premature rupture of membranes, and (ix) stillbirth. Adjusted models including hospital and demographic factors were performed with adjusted risk ratios (aRR) with 95% CIs as measures of effect.

Results

Women with epilepsy prior to delivery who received antiepileptic drugs (n = 6019) during pregnancy were not at increased risk for mortality with no deaths occurring in this group (p = .27). Risk for severe maternal morbidity in this group was approximately double (aRR 2.16, 95% CI 1.86–2.51) with risks for other outcomes including placental abruption (aRR 1.29, 95% CI 1.04–1.60), cesarean delivery (aRR 1.14, 95% CI 1.10–1.18), and preterm delivery (aRR 1.25, 95% CI 1.15–1.35) slightly increased compared to women without seizures.

Conclusion

No significant difference in mortality risk was found for women with epilepsy. Increased risk for other adverse maternal outcomes for women with epilepsy on antiepileptics was modest.

Keywords:

• Epilepsy during pregnancy
• maternal mortality
• maternal morbidity
• maternal seizure disorder

Disclosure statement

Dr. Wright has served as a consultant for Tesaro and Clovis Oncology. Dr. D’Alton has had a leadership role in ACOG II’s Safe Motherhood Initiative. Dr. Bateman is a paid consultant to Aetion, Inc and the Alosa Foundation.

Additional information

Funding

Dr. D’Alton has received unrestricted funding from Merck for Mothers. Dr. Bateman is an investigator on grants to his institution from Pfizer, Pacira, GSK, Eli Lilly, and Baxalta. Dr. Gyamfi-Bannerman disclosed receiving an unrestricted research grant paid to the institution by SMFM/AMAG and research funding from NICHD and NHLBI. Dr. Wright has received research funding from Merck.