Epilepsy Linked to Risks During Childbirth, Study Finds

But complications or maternal death during delivery are still rare, experts say

Monday, July 6, 2015

MONDAY, July 6, 2015 (HealthDay News) -- Pregnant women with epilepsy may have more than a higher risk of dying during delivery, a new study suggests.

"Specifically, there were 80 deaths per 100,000 women with epilepsy versus six deaths per 100,000 in women without epilepsy," said lead researcher Sarah MacDonald, from the department of epidemiology at Harvard T.H. Chan School of Public Health in Boston.

However, although the so-called "relative risk" of death during delivery among women with epilepsy was high, it's still a rare occurrence, MacDonald stressed.

The researchers also found that the risk of delivery complications was higher among women with epilepsy. "We also found that women with epilepsy were at increased risk for cesarean delivery, prolonged hospital stay, preeclampsia [pregnancy-related high blood pressure], preterm labor and stillbirth," she said.

Although the study found a link between epilepsy and a higher risk of certain complications or death, it's important to note that the study wasn't designed to prove that epilepsy caused those outcomes.

Dr. Jacqueline French, a professor of neurology at the Langone School of Medicine at New York University in New York City and coauthor of an accompanying journal editorial, said, "Epilepsy does increase the risk of death [in delivery]."

However, French said this study leaves a lot of questions unanswered because it doesn't look at the risk of dying during pregnancy, only during delivery.

"Was the epilepsy the reason they died or some other medical problem?" she said.

French said that the message from this study should not be that women with epilepsy are at risk of dying while giving birth. "That's a really scary thing to say because we don't have the answers based on these data," she said.

"If you have epilepsy, the great likelihood is that you are going to have a healthy, normal pregnancy and delivery," French added.

The report was published online July 6 in JAMA Neurology.

For the study, MacDonald and colleagues used U.S. medical records from delivery hospitalizations to look at birth outcomes, including maternal death, cesarean delivery, length of hospital stay, preeclampsia, preterm labor and stillbirth among pregnant women from 2007 to 2011.

The study included nearly 4.2 million deliveries, of which more than 14,100 were among women with epilepsy. In the United States, between 0.3 percent and 0.5 percent of all pregnancies occur in women with epilepsy.

The reasons for the increased risk of death and other adverse outcomes aren't known, MacDonald said.

For example, the researchers didn't have information on anti-seizure medications the women may have been taking, so they didn't know if these drugs may have had a part in the increased risk.

"While future work is needed to clarify the particular role of anti-epileptic medication on obstetric risks, our work is meaningful in that it highlights a vulnerable patient population," MacDonald said.

According to the study, women with epilepsy were more likely to suffer from other medical problems, such as depression, diabetes, kidney disease, mental disorders and alcohol and drug abuse. However, whether these conditions played a part in increasing the risk of death during childbirth isn't known.

"The study was not designed to determine the role of other medical problems the women had on the increased risks in women with epilepsy," MacDonald said.

More research is needed to understand why women with epilepsy have an increased risk and to determine what can be done to reduce these adverse outcomes, she said.

But, knowing the higher risk in women with epilepsy independent of the reasons is relevant for clinical practice and pregnancy planning, MacDonald said.

"In the meantime, it may be necessary to consider pregnancies in women with epilepsy as high risk and follow them up accordingly throughout pregnancy," she said.

SOURCES: Sarah MacDonald, Sc.M., department of epidemiology, Harvard T.H. Chan School of Public Health, Boston; Jacqueline French, M.D., professor, neurology, Langone School of Medicine at New York University, New York City ; July 6, 2015, JAMA Neurology, online

HealthDay