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Pregnant women with a history of epilepsy are at increased risk for death and complications during delivery, according to a new study.
It is estimated that women with a history of epilepsy comprise 0.3%-0.5% of all pregnancies, but there are limited data on the risk of death and complications in the pregnant epileptic patient, Sarah MacDonald of Harvard T.H. Chan School of Public Health, Boston, and her colleagues wrote in their paper published online July 6 in JAMA Neurology.
Ms. MacDonald and her associates sought to determine if patients with a history of epilepsy are at increased risk for morbidity and mortality during delivery by conducting a retrospective cohort study of a weighted sample of 20,449,532 women without and 69,385 women with epilepsy in the Nationwide Inpatient Sample from 2007 to 2011. They obtained epilepsy diagnoses and baseline characteristics from ICD-9-CM codes. To limit the possibility of nonepileptic or eclampsia seizures being recorded as epilepsy, patients in the cohort were restricted to those without a history of hypertensive disorders and the ICD-9-CM code for “epilepsy, unspecified” was removed (JAMA Neurol. 2015 July 6 [doi:10.1001/jamaneurol.2015.1017]).
Patients with a history of epilepsy had a frequency of death of 80 per 100,000 pregnancies, versus 6 deaths per 100,000 pregnancies without a history of epilepsy. The researchers noted a greater than 10-fold higher odds of death for epileptic patients (adjusted odds ratio, 11.46; 95% confidence interval, 8.64-15.19) when accounting for age, income, location, year, and race.
Pregnant women with a history of epilepsy were found to have higher rates of labor induction, cesarean section delivery, longer hospital stays, pregnancy-related hypertension, preeclampsia, and hemorrhage. Likewise, the researchers noted increased rates of gestational diabetes, premature rupture of membranes, chorioamnionitis, and premature delivery in patients with epilepsy. Furthermore, the newborns of epileptic mothers had higher rates of stillbirth, fetal distress, and poor growth. Overall, pregnant women with a history of epilepsy had significantly greater odds of severe morbidity (adjusted OR, 2.53; 95% CI, 2.44-2.63).
“However, despite their heightened risk of complications, we did not observe evidence that women with epilepsy are routinely triaged to high-risk medical centers,” the authors noted. But even though “the risk is substantially heightened on the multiplicative scale,” they said that the absolute rate of maternal death during delivery “is still very rare even among women with epilepsy.”
“Why did WWE [women with epilepsy] die at a higher rate in the MacDonald et al study? The authors suggested a number of possibilities, ranging from obstetrical complications, complications resulting from seizures (aspiration or status epilepticus), and a high rate of SUDEP (sudden unexplained death in epilepsy).”
“The MacDonald et al study provides important new information and demonstrates several risks associated with pregnancy in WWE. However, it raises far more questions than it answers. Most WWE have uncomplicated pregnancies. We need to understand the mechanisms underlying these risks, including death, so that we can identify the specific population at risk and devise interventions to reduce these risks.”
Dr. Jacqueline French is with the Comprehensive Epilepsy Center at New York University, New York. Dr. Kimford Meador is with the Stanford Comprehensive Epilepsy Center at Stanford University in Palo Alto, Calif. Dr. French reported receiving research support from multiple sources, including pharmceutical companies developing epilepsy drugs, the National Institutes of Health, the Epilepsy Therapy Project, the Epilepsy Research Foundation, and the Epilepsy Study Consortium. Dr. Meador reported receiving research support from UCB and other sources, including the National Institutes of Health, the Patient-Centered Outcomes Research Institute, and the Epilepsy Study Consortium. They made these comments in an editorial accompanying the study by Ms. MacDonald and her associates (JAMA Neurol. 2015 July 6 [doi:10.1001/jamaneurol.2015.1356]).
“Why did WWE [women with epilepsy] die at a higher rate in the MacDonald et al study? The authors suggested a number of possibilities, ranging from obstetrical complications, complications resulting from seizures (aspiration or status epilepticus), and a high rate of SUDEP (sudden unexplained death in epilepsy).”
“The MacDonald et al study provides important new information and demonstrates several risks associated with pregnancy in WWE. However, it raises far more questions than it answers. Most WWE have uncomplicated pregnancies. We need to understand the mechanisms underlying these risks, including death, so that we can identify the specific population at risk and devise interventions to reduce these risks.”
Dr. Jacqueline French is with the Comprehensive Epilepsy Center at New York University, New York. Dr. Kimford Meador is with the Stanford Comprehensive Epilepsy Center at Stanford University in Palo Alto, Calif. Dr. French reported receiving research support from multiple sources, including pharmceutical companies developing epilepsy drugs, the National Institutes of Health, the Epilepsy Therapy Project, the Epilepsy Research Foundation, and the Epilepsy Study Consortium. Dr. Meador reported receiving research support from UCB and other sources, including the National Institutes of Health, the Patient-Centered Outcomes Research Institute, and the Epilepsy Study Consortium. They made these comments in an editorial accompanying the study by Ms. MacDonald and her associates (JAMA Neurol. 2015 July 6 [doi:10.1001/jamaneurol.2015.1356]).
“Why did WWE [women with epilepsy] die at a higher rate in the MacDonald et al study? The authors suggested a number of possibilities, ranging from obstetrical complications, complications resulting from seizures (aspiration or status epilepticus), and a high rate of SUDEP (sudden unexplained death in epilepsy).”
“The MacDonald et al study provides important new information and demonstrates several risks associated with pregnancy in WWE. However, it raises far more questions than it answers. Most WWE have uncomplicated pregnancies. We need to understand the mechanisms underlying these risks, including death, so that we can identify the specific population at risk and devise interventions to reduce these risks.”
Dr. Jacqueline French is with the Comprehensive Epilepsy Center at New York University, New York. Dr. Kimford Meador is with the Stanford Comprehensive Epilepsy Center at Stanford University in Palo Alto, Calif. Dr. French reported receiving research support from multiple sources, including pharmceutical companies developing epilepsy drugs, the National Institutes of Health, the Epilepsy Therapy Project, the Epilepsy Research Foundation, and the Epilepsy Study Consortium. Dr. Meador reported receiving research support from UCB and other sources, including the National Institutes of Health, the Patient-Centered Outcomes Research Institute, and the Epilepsy Study Consortium. They made these comments in an editorial accompanying the study by Ms. MacDonald and her associates (JAMA Neurol. 2015 July 6 [doi:10.1001/jamaneurol.2015.1356]).
Pregnant women with a history of epilepsy are at increased risk for death and complications during delivery, according to a new study.
It is estimated that women with a history of epilepsy comprise 0.3%-0.5% of all pregnancies, but there are limited data on the risk of death and complications in the pregnant epileptic patient, Sarah MacDonald of Harvard T.H. Chan School of Public Health, Boston, and her colleagues wrote in their paper published online July 6 in JAMA Neurology.
Ms. MacDonald and her associates sought to determine if patients with a history of epilepsy are at increased risk for morbidity and mortality during delivery by conducting a retrospective cohort study of a weighted sample of 20,449,532 women without and 69,385 women with epilepsy in the Nationwide Inpatient Sample from 2007 to 2011. They obtained epilepsy diagnoses and baseline characteristics from ICD-9-CM codes. To limit the possibility of nonepileptic or eclampsia seizures being recorded as epilepsy, patients in the cohort were restricted to those without a history of hypertensive disorders and the ICD-9-CM code for “epilepsy, unspecified” was removed (JAMA Neurol. 2015 July 6 [doi:10.1001/jamaneurol.2015.1017]).
Patients with a history of epilepsy had a frequency of death of 80 per 100,000 pregnancies, versus 6 deaths per 100,000 pregnancies without a history of epilepsy. The researchers noted a greater than 10-fold higher odds of death for epileptic patients (adjusted odds ratio, 11.46; 95% confidence interval, 8.64-15.19) when accounting for age, income, location, year, and race.
Pregnant women with a history of epilepsy were found to have higher rates of labor induction, cesarean section delivery, longer hospital stays, pregnancy-related hypertension, preeclampsia, and hemorrhage. Likewise, the researchers noted increased rates of gestational diabetes, premature rupture of membranes, chorioamnionitis, and premature delivery in patients with epilepsy. Furthermore, the newborns of epileptic mothers had higher rates of stillbirth, fetal distress, and poor growth. Overall, pregnant women with a history of epilepsy had significantly greater odds of severe morbidity (adjusted OR, 2.53; 95% CI, 2.44-2.63).
“However, despite their heightened risk of complications, we did not observe evidence that women with epilepsy are routinely triaged to high-risk medical centers,” the authors noted. But even though “the risk is substantially heightened on the multiplicative scale,” they said that the absolute rate of maternal death during delivery “is still very rare even among women with epilepsy.”
Pregnant women with a history of epilepsy are at increased risk for death and complications during delivery, according to a new study.
It is estimated that women with a history of epilepsy comprise 0.3%-0.5% of all pregnancies, but there are limited data on the risk of death and complications in the pregnant epileptic patient, Sarah MacDonald of Harvard T.H. Chan School of Public Health, Boston, and her colleagues wrote in their paper published online July 6 in JAMA Neurology.
Ms. MacDonald and her associates sought to determine if patients with a history of epilepsy are at increased risk for morbidity and mortality during delivery by conducting a retrospective cohort study of a weighted sample of 20,449,532 women without and 69,385 women with epilepsy in the Nationwide Inpatient Sample from 2007 to 2011. They obtained epilepsy diagnoses and baseline characteristics from ICD-9-CM codes. To limit the possibility of nonepileptic or eclampsia seizures being recorded as epilepsy, patients in the cohort were restricted to those without a history of hypertensive disorders and the ICD-9-CM code for “epilepsy, unspecified” was removed (JAMA Neurol. 2015 July 6 [doi:10.1001/jamaneurol.2015.1017]).
Patients with a history of epilepsy had a frequency of death of 80 per 100,000 pregnancies, versus 6 deaths per 100,000 pregnancies without a history of epilepsy. The researchers noted a greater than 10-fold higher odds of death for epileptic patients (adjusted odds ratio, 11.46; 95% confidence interval, 8.64-15.19) when accounting for age, income, location, year, and race.
Pregnant women with a history of epilepsy were found to have higher rates of labor induction, cesarean section delivery, longer hospital stays, pregnancy-related hypertension, preeclampsia, and hemorrhage. Likewise, the researchers noted increased rates of gestational diabetes, premature rupture of membranes, chorioamnionitis, and premature delivery in patients with epilepsy. Furthermore, the newborns of epileptic mothers had higher rates of stillbirth, fetal distress, and poor growth. Overall, pregnant women with a history of epilepsy had significantly greater odds of severe morbidity (adjusted OR, 2.53; 95% CI, 2.44-2.63).
“However, despite their heightened risk of complications, we did not observe evidence that women with epilepsy are routinely triaged to high-risk medical centers,” the authors noted. But even though “the risk is substantially heightened on the multiplicative scale,” they said that the absolute rate of maternal death during delivery “is still very rare even among women with epilepsy.”
FROM JAMA NEUROLOGY
Key clinical point: Epilepsy is associated with increased risk of maternal death and complications surrounding delivery.
Major finding: Pregnant women with a history of epilepsy had a 10-fold increased likelihood of death (adjusted OR, 11.46; 95% CI, 8.64-15.19) and higher rates of complications.
Data source: A retrospective cohort study of pregnant women using data obtained from the Nationwide Inpatient Sample from 2007 to 2011.
Disclosures: The authors reported no conflicts of interest. The study was supported by a grant from the National Institute of Mental Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.