Epilepsy and ASM use in pregnancy increase morbidity and mortality risks in women and their offspring

Women with epilepsy are at considerably higher risk of severe maternal and perinatal outcomes and increased risk of death during pregnancy and postpartum, and the use of antiseizure medications (ASM) further increases these risks, the largest study to date has found.

The Scandinavian multiregistry study of antiepileptic drug teratogenicity (SCAN-AED), which included a multinational cohort of 4,511,267 deliveries (of which 4,475,984 were to mothers without epilepsy and 35,283 to mothers with epilepsy) from the Nordic register, found that compared with women without epilepsy, those with epilepsy had approximately four-fold higher risk of death in pregnancy and the postpartum period (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). The epilepsy cohort was restricted to individuals whose epilepsy onset occurred before childbirth and those with active epilepsy (ie, diagnosis code for epilepsy within 10 years prior to conception). [JAMA Neurol 2024;81:985-995]

The rate of composite severe maternal morbidity was also higher in women with epilepsy (36.9 vs 25.3 per 1,000 deliveries) than in women without epilepsy. Among the specific conditions considered as severe maternal morbidity, severe preeclampsia, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, or eclampsia, embolism, disseminated intravascular coagulation, or shock, cerebrovascular events, and severe mental health conditions showed particularly elevated odds.