WASHINGTON — Women with epilepsy are at a more than 10-fold higher risk for maternal death and are at increased risk for many adverse outcomes during pregnancy when compared with women who do not have the condition, results of a large study indicate.

These findings underscore that women with epilepsy might benefit from a higher level of labor floor vigilance, Thomas F. McElrath, MD, PhD, a study researcher from the Harvard Medical School in Boston, said during a presentation at the 2015 American Academy of Neurology Annual Meeting.

“This group of patients deserves more than the standard type of obstetrical care during the intrapartum period,” McElrath said. “That is not a new idea for obstetrics, as we do this for diabetic patients and those who are paralyzed, for example. But what is new is the idea that the epileptic population may deserve this extra type of consideration.”

Epilepsy Ups Mortality, Morbidity

In the study, McElrath and colleagues culled together data from the 2007 to 2011 Nationwide Inpatient Sample to compare delivery hospitalizations in women with vs. without epilepsy.

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Overall, the weighted sample included 69,385 women with epilepsy and 20,449,532 women without epilepsy.

Compared with women who did not have epilepsy, those who did were at a significantly increased risk for death during delivery hospitalization (80 per 100,000 vs. 6 per 100,000; OR=11.46; 95% CI, 8.64-15.196). After adjustment for demographic characteristics, this relationship remained (adjusted RR=11.72; 95% CI, 8.69-15.80).

“No one could have predicted such a high risk of mortality, particularly since it is such a rare outcome [during delivery],” Sarah MacDonald, an epidemiology graduate student also at Harvard, told Neurology Advisor. “You would need to observe 100,000s of cases to be able to predict that outcome. I think our dataset is unique in that it is so large.”

In addition, women with epilepsy were also at increased risk for preeclampsia (OR=1.59; 95% CI, 1.54-1.63) and preterm labor (OR=1.54; 95% CI, 1.50-1.575), and were more likely to have a cesarean section (OR=1.40; 95% CI, 1.38-1.42) and prolonged length of hospital stay (>6 day stay; RR=2.54; 95% CI, 2.43-2.65).

Hospital characteristics for women with epilepsy were very similar in terms of bed size and annual number of deliveries compared with women without epilepsy.

“We didn’t find that [women with epilepsy] were being triaged to the higher-risk hospitals,” she said. “That was something we weren’t expecting.”

Potential Implications

Some of these outcomes conflict with a 2009 American Academy of Neurology report, which stated that women with epilepsy are not at a substantially increased risk for cesarean section or preterm labor, along with pregnancy-related bleeding, MacDonald noted.

“Some of those recommendations may need to be revised,” McElrath said. “Our intuition is that [women with epilepsy] may have an increased risk for preeclampsia. So I think this is a group that needs a thorough second look.”

Putting the Findings Into Perspective

Although the mortality rate was higher than expected, both researchers were quick to point out that women with epilepsy are still at very low risk for maternal mortality overall.

“One of the great unsung triumphs of Western medicine is that we have taken maternal mortality from an event that occurred historically (at the percent level) down to the one per 10,000 level,” McElrath said.

“So I don’t want to scare people, but I do want to bring to the providers’ attention that these patients aren’t standard patients who happen to take another kind of medicine. And this really gives us a lot of room for additional research, which could be very exciting.”

Reference

MacDonald SC et al. Abstract S45.007. Presented at: American Academy of Neurology Annual Meeting 2015; April 18-25, 2015: Washington, D.C.

Video Editor: Brianne Aiken; Videographer/Producer: Nicole Blazek