New Urgency Over Pregnant Women With Epilepsy, Their Foetuses, and Neonates

TOPLINE:

Pregnant women with epilepsy are at higher risk for severe maternal, foetal, and neonatal outcomes, including death, according to the largest study to date of 4.5 million deliveries in five Nordic countries.

METHODOLOGY:

• This study was a prospective cohort of 4,511,267 deliveries, of which 35,283 were to mothers with epilepsy and 4.475 million were to mothers without epilepsy in Denmark, Finland, Iceland, Norway, and Sweden (1996-2017).
• The study also was of antiseizure medication use (n = 16,240) vs non-use (n = 19,043) among mothers with epilepsy.
• The primary outcomes were a composite of severe maternal outcomes and a composite of severe perinatal (foetus and neonatal) outcomes.
• Findings were adjusted for maternal age, parity, birth year, number of chronic conditions, among other confounders.

TAKEAWAY:

• There was a 23% increase in composite maternal death and morbidity (adjusted odds ratio [aOR], 1.23; 95% CI, 1.16-1.31) among mothers with epilepsy vs those without.
  • The three greatest maternal risks were for mortality (aOR, 3.86; 95% CI, 1.84-8.10), cerebrovascular accidents (aOR, 5.81; 95% CI, 4.27-7.89), and severe mental health conditions (aOR, 1.81; 95% CI, 1.50-2.19).
• Adverse perinatal outcomes included a 44% increase in composite perinatal death/severe neonatal morbidity (aOR, 1.44; 95% CI, 1.37-1.52), including a 48% increase in composite severe neonatal morbidity (aOR, 1.48; 95% CI, 1.40-1.56), and an 18% increase in stillbirth (aOR, 1.18; 95% CI, 1.00-1.40) compared with outcomes among mothers without epilepsy.
• Antiseizure medication use vs non-use by women with epilepsy was associated with a higher risk for neonatal death (aOR, 2.40; 95% CI, 1.44-4.00), cerebrovascular accidents (aOR, 1.99; 95% CI, 1.13-3.50), and perinatal death (aOR, 1.40; 95% CI, 1.03-1.89).
• With regard to specific antiseizure medication vs non-use, the likelihood of severe maternal morbidity was increased for valproate (aOR, 1.67; 95% CI, 1.26-2.23), carbamazepine (aOR, 1.46; 95% CI, 1.14-1.87), and oxcarbazepine (aOR, 1.53; 95% CI, 1.08-2.17).

IN PRACTICE:

The authors concluded, “While most women with epilepsy have uncomplicated pregnancies, there is an urgent need for enhanced counselling, perinatal support, and access to specialised care for safe deliveries in all women with epilepsy.”

SOURCE:

The lead and corresponding author is Neda Razaz, PhD, of the Karolinska Institutet, Stockholm, Sweden. The study appeared in JAMA Neurology.

LIMITATIONS:

Limitations included an observational design, a unknown compliance with antiseizure medication prescriptions, and a lack of adjustment for multiple comparisons for some outcomes.

DISCLOSURES:

Several authors reported conflicts of interest. The funding sources included the NordForsk Nordic Program on Health and Welfare and Research Council of Norway.