Global variation in pregnancy complications in women with epilepsy: A meta-analysis

Allotey, John; Aroyo-Manzano, David; Lopez, Patricia; Viale, Luz; Zamora, Javier; Thangaratinam, Shakila

doi:10.1016/j.ejogrb.2017.05.016

Cited by 24 publications

(18 citation statements)

References 26 publications

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“…Tomson et al, 11 in the EURAP Registry, report SFL in only 9.0% (632 of 7055) of pregnancies, but participants could enter the study as late as the 16th week of gestation, by which time more than 80% of SFL may occur. 11 In the prospective, rigorously monitored Women With Epilepsy: Pregnancy Outcomes and Deliveries investigation of women with epilepsy and control individuals seeking pregnancy, 9 miscarriage was reported in 12.9% of women with epilepsy and 19.7% of control individuals. If, as the EBCR findings suggest, unplanned pregnancies make up 65% of pregnancies in women with epilepsy, 2 and unplanned pregnancies in women with epilepsy carry a 2.14 risk ratio for SFL, the SFL rate of 12.9% in planned pregnancies in the WEPOD study would suggest an overall SFL rate of 22.5% in women with epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Association of Unintended Pregnancy With Spontaneous Fetal Loss in Women With Epilepsy

2019

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If unintended pregnancy is common among women with epilepsy and is associated with increased risk of spontaneous fetal loss (SFL), it is important to develop guidelines for safe and effective contraception for this community. OBJECTIVE To assess whether planned pregnancy is a determinant of SFL in women with epilepsy. DESIGN, SETTING, AND PARTICIPANTS The Epilepsy Birth Control Registry conducted this web-based, retrospective survey between 2010 and 2014. It gathered demographic, epilepsy, antiepileptic drug (AED), contraceptive, and reproductive data from 1144 women with epilepsy in the community between ages 18 and 47 years. Data were analyzed between March 2018 and May 2018. MAIN OUTCOMES AND MEASURES The primary outcome was the risk ratio (RR) with 95% confidence intervals for SFL in unplanned vs planned pregnancies. The secondary outcome was the identification of some potentially modifiable variables (maternal age, pregnancy spacing, and AED category) of SFL vs live birth using binary logistic regression. RESULTS The participants were proportionally younger (mean [SD] age, 28.5 [6.8] years), and 39.8% had household incomes of $25 000 or less. Minority women represented only 8.7% of the participants. There were 530 of 794 unplanned pregnancies (66.8%) and 264 of 794 planned pregnancies (33.2%). The risk for SFL in 653 unaborted pregnancies in women with epilepsy was greater for unplanned (n = 137 of 391; 35.0%) than planned (n = 43 of 262; 16.4%) pregnancies (RR, 2.14; 95% CI, 1.59-2.90; P < .001). Regression analysis found that the risk for SFL was greater when planning was entered alone (odds ratio [OR], 2.75; 95% CI, 1.87-4.05; P < .001) and more so when adjusted for maternal age, interpregnancy interval, and AED category (OR, 3.57; 95% CI, 1.54-8.78; P = .003). Interpregnancy interval (OR, 2.878; 95% CI, 1.8094-4.5801; P = .008) and maternal age (OR, 0.957; 95% CI, 0.928-0.986 for each year from 18 to 47 years; P = .02), but not AED category, were also associated. The risk was greater when interpregnancy interval was less than 1 year (n = 56 of 122; 45.9%) vs greater than 1 year (n = 56 of 246; 22.8%) (RR, 2.02; 95% CI, 1.49-2.72; P < .001). Relative to the younger than 18 years cohort (n = 15 of 29; 51.7%), the risks were lower for the intermediate older cohort aged 18 to 27 years (n = 118 of 400; 29.5%; RR, 0.57; 95% CI, 0.39-0.84; P < .004) and the cohort aged 28 to 37 years (n = 44 of 212; 20.8%; RR, 0.40; 95% CI, 0.26-0.62; P < .001) but not significantly different for the small number of participants in the aged 38 to 47 years cohort (n = 3 of 12; 25.0%). No individual AED category's SFL frequency differed significantly from the no AED category. CONCLUSIONS AND RELEVANCE The Epilepsy Birth Control Registry retrospective survey finding that unplanned pregnancy in women with epilepsy may double the risk for SFL warrants prospective investigation with outcome verification.

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Section: Discussionmentioning

confidence: 99%

Association of Unintended Pregnancy With Spontaneous Fetal Loss in Women With Epilepsy

2019

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“…A previous meta-analysis studying maternal complications in WWE presented temporal changes by comparing different geographical populations. [31] Without any reference populations, they reported an increase over time in caesarean section rates and induction of labour for WWE. We found elective caesarean section to be more frequent in WWE than in women without epilepsy, but without any increase over time.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis indicates a trend towards increasing rates of caesarean section and induction of labour in WWE. [31] However, different geographical populations with great variation in obstetric practice were compared to describe differences over time, and no reference populations were included. Therefore, it is not known how changes in population characteristics, obstetric practice and general complication rates have affected WWE.…”

Section: Introductionmentioning

confidence: 99%

Maternal complications in pregnancy and childbirth for women with epilepsy: Time trends in a nationwide cohort

et al. 2019

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ObjectiveObstetric trends show changes in complication rates and maternal characteristics such as caesarean section, induced labour, and maternal age. To what degree such general time trends and changing patterns of antiepileptic drug use influence pregnancies of women with epilepsy (WWE) is unknown. Our aim was to describe changes in maternal characteristics and obstetric complications in WWE over time, and to assess changes in complication risks in WWE relative to women without epilepsy.MethodsThis was a nationwide cohort study of all first births in the Medical Birth Registry of Norway, 1999–2016. We estimated maternal characteristics, complication rates, and risks for WWE compared to women without epilepsy. Main maternal outcome measures were hypertensive disorders, bleeding in pregnancy, induction of labour, caesarean section, postpartum hemorrhage, preterm birth, small for gestational age, and epidural analgesia. Time trends were analyzed by logistic regression and comparisons made with interaction analyses.Results426 347 first births were analyzed, and 3077 (0.7%) women had epilepsy. In WWE there was an increase in proportions of induced labour (p<0.005) and use of epidural analgesia (p<0.005), and a reduction in mild preeclampsia (p = 0.006). However, the risk of these outcomes did not change over time. Only the risk of severe preeclampsia increased significantly over time relative to women without epilepsy (p = 0.006). In WWE, folic acid supplementation increased significantly over time (p<0.005), and there was a decrease in smoking during pregnancy (p<0.005), but these changes were less pronounced than for women without epilepsy (p<0.005).ConclusionsDuring 1999–2016 there were important changes in maternal characteristics and complication rates among WWE. However, outcome risks for WWE relative to women without epilepsy did not change despite changes in antiepileptic drug use patterns. The relative risk of severe preeclampsia increased in women with epilepsy.

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“…A recent systematic review found important variation exists in maternal and fetal outcomes among WWE by geographical region, economic status, and time. (Allotey, 2017) As such, our survey instrument may be useful for other future studies in LMICs as a concise tool to understand reproductive and maternal histories among WWE.…”

Section: Discussionmentioning

confidence: 99%

Contraception, pregnancy, and peripartum experiences among women with epilepsy in Bhutan

et al. 2017

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Global variation in pregnancy complications in women with epilepsy: A meta-analysis

Abstract: There is significant variation in reported maternal and offspring outcomes in pregnant women with epilepsy across geographical regions, economic status of country and over time, which needs to be considered in setting priorities for clinical management and research.

Cited by 24 publications

References 26 publications

Association of Unintended Pregnancy With Spontaneous Fetal Loss in Women With Epilepsy

Association of Unintended Pregnancy With Spontaneous Fetal Loss in Women With Epilepsy

Maternal complications in pregnancy and childbirth for women with epilepsy: Time trends in a nationwide cohort

Contraception, pregnancy, and peripartum experiences among women with epilepsy in Bhutan

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