Study Reveals Higher Risks of Severe Maternal and Perinatal Outcomes in Women with Epilepsy

Maternal epilepsy and the use of antiseizure medication (ASM) during pregnancy were linked to higher rates of maternal health complications as well as increased perinatal mortality and morbidity, the researchers wrote in JAMA Neurology.

Previous studies have shown that maternal epilepsy is associated with negative pregnancy and neonatal outcomes. Gaining a deeper understanding of this condition and its associated risks at delivery could help mitigate these adverse effects. Considering this, Neda Razaz, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden, and colleagues aimed to determine the risk of severe maternal and perinatal morbidity and mortality among women with epilepsy.

For this purpose, the researchers conducted a prospective population-based register study in Denmark, Finland, Iceland, Norway, and Sweden from 1996 to 2017, with data analysis completed between August 2022 and November 2023. The study included all singleton births at 22 weeks gestation or longer, excluding those with missing or invalid birth weight or gestational length data. A total of 4,511,267 deliveries were identified, comprising 4,475,984 births to women without epilepsy and 35,283 to mothers with epilepsy.

The study examined maternal epilepsy diagnoses recorded before childbirth and prenatal exposure to antiseizure medication (ASM), defined as any maternal prescription filled from conception to childbirth. The main outcomes assessed were severe maternal morbidity and mortality during pregnancy or within 42 days postpartum, as well as severe neonatal morbidity (such as neonatal convulsions) and perinatal mortality (including stillbirths and deaths within the first 28 days of life).

The following were the key findings of the study:

• The mean age at delivery for women in the epilepsy cohort was 29.9 years. The rate of composite severe maternal morbidity and mortality was also higher in women with epilepsy compared with those without epilepsy (36.9 vs 25.4 per 1000 deliveries).
• Women with epilepsy also had a significantly higher risk of death (0.23 deaths per 1000 deliveries) compared with women without epilepsy (0.05 deaths per 1000 deliveries), with an aOR of 3.86.
• Maternal epilepsy was associated with increased odds of severe preeclampsia, embolism, disseminated intravascular coagulation or shock, cerebrovascular events, and severe mental health conditions.
• Fetuses and infants of women with epilepsy were at elevated odds of mortality (aOR, 1.20) and severe neonatal morbidity (aOR, 1.48).
• In analyses restricted to women with epilepsy, women exposed to ASM compared with those unexposed had higher odds of severe maternal morbidity (aOR,1.24), and their neonates had increased odds of mortality and severe morbidity (aOR, 1.37).

"The findings suggest that, although most women with epilepsy experience uncomplicated pregnancies, there is an urgent need for improved counseling, perinatal support, and access to specialized care to ensure safe deliveries for all women with epilepsy," the researchers concluded.

Reference:

Razaz N, Igland J, Bjørk M, et al. Risk of Perinatal and Maternal Morbidity and Mortality Among Pregnant Women With Epilepsy. JAMA Neurol. Published online August 05, 2024. doi:10.1001/jamaneurol.2024.2375