Mother and infant

Summary of:

MacDonald SC, Bateman BT, McElrath TF, Hernández-Díaz S. Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States. JAMA Neurol. 2015;72(9):981-988.

Medical professionals understand that women with epilepsy (WWE) need special attention both before and during pregnancy to optimize outcomes in terms of maternal seizure control and fetal growth and development. It has become standard of care for neurologists to inquire about pregnancy planning, use of birth control, and vitamin supplements in women of childbearing age with epilepsy. In pregnant WWE, levels of antiepileptic medications are closely monitored and doses adjusted to ensure continued seizure control during this critical period. But what about at the time of delivery?

Do mothers with epilepsy need special attention as they prepare to give birth?

A new study by MacDonald, et al, suggests that the answer is yes.

This is a retrospective cohort study using a large database from 20% of U.S. hospitals with a sample including 69,385 WWE and 20,449,532 women without epilepsy who gave birth between 2007 and 2011. The size of this sample allowed for more accurate comparisons to be drawn despite the relative infrequency of births in WWE.

The data suggest that WWE are at a significantly higher risk than women without epilepsy for a number of complications around the time of delivery, including:

  • Preeclampsia
  • Seizures associated with preeclampsia
  • Antepartum hemorrhage
  • Postpartum hemorrhage
  • Premature delivery
  • Premature rupture of membranes
  • Chorioamnionitis

Perhaps most worrisome is the finding that WWE have more than a 10-fold increase in the risk of death around the time of delivery. The paper clarifies that the risk of maternal death is still quite low, even among WWE (80 deaths per 100,000 pregnancies), but the heightened risk for WWE compared to other women should be taken into consideration when planning for deliveries in this population.

At this time, there is no evidence that WWE are routinely sent to high-risk medical centers for delivery. The authors concede that their study does not answer the question of why WWE are at higher risk of death, nor what interventions could improve these outcomes, but it certainly raises the level of concern and highlights the need for further research to answer these questions.

Authored By: 
Kristine Ziemba MD, PhD
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Authored Date: 
12/2015