Seizures

Abstract

Epilepsy is a common disease that affects 1.5 million women of childbearing age in the United States. Approximately 24,000 women with epilepsy give birth each year. The challenges for women with epilepsy extend from menarche to postmenopause, including prepregnancy, pregnancy, intrapartum and postpartum periods, menopause, and postreproductive age. The most up-to-date neurology and epilepsy guidelines provided in this monograph will enable obstetrician–gynecologists to provide care to women with this complex condition across the life span.

Association of Epilepsy and Severe Maternal Morbidity

“…Our results are important in light of conflicting evidence regarding the risk of pregnancy complications for patients with epilepsy. [3][4][5][6]9,19,20 Although it is reassuring that the majority of these patients (95.7%) did not experience SMM, the increased risk we identified is similar to what has been reported previously. 4 The persistent risk even after accounting for comorbidities further underscores the importance of physician awareness when managing patients with epilepsy.…”

“…9 Seizures themselves can cause hypoxia, aspiration, or trauma from falls, which can contribute to SMM events such as pulmonary edema. 3 Although these types of events were more common for patients with epilepsy, other events such as those related to hemorrhage were also increased. Furthermore, though eclampsia contributed to SMM, it did not occur in 84.6% of patients with epilepsy who experienced SMM.…”

“…8 Although patients with epilepsy have increased maternal mortality, evidence has been conflicting regarding their risk of pregnancy complications. 3,4,9 This may be due to variability in seizure type and control, or to the rarity of specific outcomes, such as eclampsia, which have been studied. In an attempt to understand rare complications that might contribute to maternal mortality, the severe maternal morbidity (SMM) composite was developed by the Centers for Disease Control and Prevention (CDC).…”

“…1,2 Approximately 24,000 patients with epilepsy deliver annually, accounting for 0.3–0.5% of all births. 3,4 In these patients, the risk of maternal mortality may be as much as 11 times higher than the general population. 4–7 Seventy-nine percent of maternal deaths in a recent cohort of patients with epilepsy were considered to be sudden and unexpected, suggesting that an improved understanding of maternal mortality with epilepsy is warranted.…”