Association of Epilepsy and Severe Maternal Morbidity

Abstract

OBJECTIVE: To evaluate severe maternal morbidity (SMM) among patients with epilepsy and patients without epilepsy. METHODS: We retrospectively examined SMM using linked birth certificate and maternal hospital discharge records in California between 2007 and 2012. Epilepsy present at delivery admission was the exposure and was subtyped into generalized, focal and other less specified, or unspecified. The outcomes were SMM and nontransfusion SMM from delivery up to 42 days’ postpartum, identified using Centers for Disease Control and Prevention indicators. Multivariable logistic regression models were used to adjust for confounders, which were selected a priori. We also estimated the association between epilepsy and SMM independent of comorbidities by using a validated obstetric comorbidity score. Severe maternal morbidity indicators were then compared using the same multivariable logistic regression models. RESULTS: Of 2,668,442 births, 8,145 (0.3%) were to patients with epilepsy; 637 (7.8%) had generalized, 6,250 (76.7%) had focal or other less specified, and 1,258 (15.4%) had unspecified subtypes. Compared with patients without epilepsy, patients with epilepsy had greater odds of SMM (4.3% vs 1.4%, adjusted odds ratio [aOR] 2.91, 95% CI 2.61–3.24) and nontransfusion SMM (2.9% vs 0.7%, aOR 4.16, 95% CI 3.65–4.75). Epilepsy remained significantly associated with increased SMM and nontransfusion SMM after additional adjustment for the obstetric comorbidity score, though the effects were attenuated. When grouped by organ system, all SMM indicators were significantly more common among patients with epilepsy—most notably those related to hemorrhage and transfusion. CONCLUSION: Severe maternal morbidity was significantly increased in patients with epilepsy, and SMM indicators across all organ systems contributed to this.

Comparison of Perinatal Outcomes for Women With and Without Epilepsy

“…There were 45 retrospective 3,[5][6][7][8][9][10][13][14][15]19,20,[22][23][24][25] and 21 prospective 11, [16][17][18]21,26,[60][61][62][63][64][65][66][67][68][69][70][71][72][73][74] cohort studies, 9 case-control studies, 4,12,75-81 and 1 cross-sectional study. 82 Sixty-two articles had a low risk of bias 3-11, 13-16, 18-26, 31-40, 42, 45, 46, 48, 50-60, 62-71,74-77,79 and 14 a high risk of bias 12,17,41,43,44,47,49,61,72,73,78,[80][81][82] (eTable 2 in Supplement 1).…”

“…There were 45 retrospective 3,5-10,13-15,19,20,22-25,31-59 and 21 prospective 11,16-18,21,26,60-74 cohort studies, 9 case-control studies, 4,12,75-81 and 1 cross-sectional study. 82 Sixty-two articles had a low risk of bias [3][4][5][6][7][8][9][10][11][13][14][15][16][18][19][20][21][22][23][24][25][26][31][32][33][34][35][36][37][38][39][40]42,45,46,48,[50][51][52][53][54][55][56][57][58][59][60][62][63][64][65][66][67]…”

“…There were 45 retrospective and 21 prospective cohort studies, 9 case-control studies, and 1 cross-sectional study . Sixty-two articles had a low risk of bias and 14 a high risk of bias (eTable 2 in Supplement 1).…”

“…A systematic review and meta-analysis of observational studies investigated the association between maternal epilepsy and reproductive outcomes (with or without ASM exposure) using data from studies from January 1, 1990, to January 21, 2015. However, that study did not investigate many outcomes of clinical interest, including likelihood for offspring congenital conditions or maternal death, and a number of important studies have been conducted since then . One of these studies found an 11-fold increased adjusted odds of maternal death for pregnant women with epilepsy, and another, in contrast to findings of the previous review, found that women with epilepsy had increased odds of preterm birth …”

Contemporary management of epilepsy in pregnancy

“…The SMM composite includes 21 events, such as eclampsia and cardiac arrest, that occur during delivery hospitalization and result in significant consequences, as defined by the Centers for Disease Control and Prevention (CDC). Panelli et al [27 ▪ ] found a three-fold increased risk of SMM and four-fold increased risk of nontransfusion SMM in people with epilepsy compared with those without. When characterized by organ systems, all SMM indicators were significantly increased, particularly those related to haemorrhage and transfusion [27 ▪ ].…”