Epilepsy ups maternal, perinatal risks in pregnant women

Pregnant women with epilepsy face considerably greater risk of severe morbidity as well as maternal and perinatal mortality, according to a study.

For the study, researchers looked at 4,511,267 singleton births at 22 weeks of gestation or longer across Denmark, Finland, Iceland, Norway, and Sweden. Of these births, 4,475,984 were to women without epilepsy and 35,283 were to women with epilepsy (mean age at delivery 29.9 years).

Outcome measures included (1) composite severe maternal morbidity and mortality occurring in pregnancy or within 42 days postpartum and (2) composite severe neonatal morbidity (eg, neonatal convulsions) and perinatal mortality (ie, stillbirths and deaths) during the first 28 days of life.

Composite severe maternal morbidity and mortality occurred more frequently among women with epilepsy than among those without epilepsy (36.9 vs 25.4 per 1,000 deliveries). In addition, women with epilepsy had a significantly higher risk of death (0.23 vs 0.05 deaths per 1,000 deliveries; adjusted odds ratio [aOR], 3.86, 95 percent confidence interval [CI], 1.48–8.10).

Maternal epilepsy was associated with increased odds of severe outcomes including pre-eclampsia, embolism, disseminated intravascular coagulation or shock, cerebrovascular events, and severe mental health conditions. Likewise, maternal epilepsy was associated with greater odds of foetal and infant death (aOR, 1.20, 95 percent CI, 1.05–1.38) and severe neonatal morbidity (aOR, 1.48, 95 percent CI, 1.40–1.56).

Analyses restricted to women with epilepsy showed that exposure to antiseizure medications contributed to greater odds of severe maternal morbidity (aOR ,1.24, 95 percent CI, 1.10–1.48) and neonatal mortality and severe morbidity (aOR, 1.37, 95 percent CI, 1.23–1.52).