Clinical characteristics and fetal outcomes in women with epilepsy with planned and unplanned pregnancy: a retrospective study

Abstract

Objective: To compare the antiepileptic drug (AED) patterns, seizure control, and folic acid supplementation between planned and unplanned pregnancy in women with epilepsy (WWE), and investigate the effects of planned pregnancy on fetal outcomes. Design: Retrospective study. Setting: A prospectively collected database from Feb 2010 to Dec 2018 in Xijing Hospital. Populations: Pregnant WWE. Main Outcome Measures: Clinical characteristics and fetal outcomes. Results: 477 pregnancies were enrolled: 188 planned pregnancies (39.4%) and 289 unplanned pregnancies (60.6%). The education level of the unplanned group was lower than that of the planned group (P < 0.001). Among the planned group, 66.0% took AED monotherapy, and 32.4% received polytherapy. In the unplanned group, 58.1% did not take AEDs, 28.0% took monotherapy, and 12.8% received polytherapy. Compared with the unplanned group, The planned group had less generalized tonic-clonic seizures (2 [1-4] vs. 1 [1-2]; P = 0.002) and a higher proportion of being seizure-free (41.0% vs. 22.8%; P < 0.001). All planned pregnancies took folic acid while 39.8% of unplanned pregnancies never took it (P < 0.001). The planned group showed significantly less adverse fetal outcomes than the unplanned group: induced abortions (2.7% vs. 13.5%; P < 0.001), preterm births (3.3% vs. 20.4%; P < 0.001), and major congenital malformations within one year of delivery (1.6% vs. 7.5%; P = 0.016). Regression analysis demonstrated that pregnancy planning was independently associated with adverse fetal outcomes (adjusted odds ratio, 0.14; 95% confidence interval, 0.08-0.27; P < 0.001). Conclusions: Planned-pregnancy could benefit both WWE and their offspring.

Preventive Approaches in Women's Neurology: Prepartum, Pregnancy, and Postpartum

“…In addition, planning for pregnancy, and avoiding unplanned pregnancy, has been associated with higher rates of seizure freedom during pregnancy, higher rates of folic acid supplementation, fewer pre-term births, and fewer major congenital malformations. 26 For that reason, neurologists caring for women with epilepsy should counsel them on the risks of unplanned pregnancy and the benefits of providing notice in advance to their healthcare professionals of their intentions to attempt to conceive.…”