Increased risk of death during delivery for women with epilepsy

By Lucy Piper, Senior medwireNews Reporter

Pregnant women with epilepsy have a more than 10-fold increased risk of death during hospitalisation for delivery, show study findings that suggest the need for increased clinical attention for these pregnancies.

The study of a weighted nationwide sample of approximately 20 million women discharged from hospital between 2007 and 2011 after giving birth showed that, although rare, the risk of death was significantly higher for the 69,385 who had epilepsy than the 20,449,532 without, at 80 versus six deaths per 100,000 pregnancies.

The researchers, led by Sarah MacDonald (Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA), did not have information on the ultimate causes of death, but they say that “[r]egardless of the specific cause, the point that women recorded as having epilepsy have an increased risk of mortality remains a clinically relevant message”.

Women with epilepsy were also a significant 2.53 times more likely than women without epilepsy to experience any severe maternal morbidity, according to the Centers for Disease Control and Prevention composite outcome.

Specifically, after adjusting for maternal age and race, household income and hospital location, women with epilepsy had a heightened risk of preeclampsia (odds ratio [OR]=1.59), preterm labour (OR=1.54) and stillbirth (OR=1.27).

They were also more likely than women without epilepsy to undergo a caesarean delivery (OR=1.40) and stay in hospital for more than 6 days, with ORs of 2.13 following a caesarean delivery and 2.60 following vaginal deliveries.

Complications were not restricted to the women; the findings showed that babies born to women with epilepsy were at significantly increased risk of poor intrauterine growth, preceding foetal distress and congenital abnormalities.

“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 team writes in JAMA Neurology.

They suggest that women with epilepsy would be “best cared for in medical centers with subspecialty expertise in neurology, maternal-fetal medicine, and critical care.”

But Jacqueline French (New York University, USA) and Kimford Meador (Stanford University School of Medicine, Palo Alto, California, USA) point out in a related editorial that “considering all [women with epilepsy] as high risk, might lead to unnecessary health care costs”.

They note that most women with epilepsy have uncomplicated pregnancies, so “[w]e 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”, they conclude.

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