Epilepsy Is Linked to Adverse Maternal Outcomes

Patients with epilepsy are more likely to have adverse maternal outcomes, according to a study published in Epilepsia journal.

Researchers examined the effect of epilepsy on maternal outcomes among adults with deliveries of live singleton or still births between 2018 and 2023, with each delivery counted separately. Primary outcomes included mode of delivery, length of postpartum hospitalizations, and breastfeeding initiation. Secondary outcomes were rates of labor inductions vs spontaneous labor, primary cesarean deliveries, preterm delivery, postpartum hemorrhage, placental abruption, and preeclampsia.

A total of 29,621 patients who had 33,764 deliveries were included in the study. Of these, 167 patients with a comorbid diagnosis of epilepsy had 199 deliveries (median age at delivery, 28 years [IQR, 24-33]; 54.1% White).

While there were no significant differences between participants with and without epilepsy in mode of delivery, a diagnosis of epilepsy resulted in longer postpartum hospital stay (≥3 days; 33.2% vs 25.2%; P =.010) and lower rate of breastfeeding initiation after delivery (82.2% vs 89.9%; P =.001). Participants with vs without epilepsy also had a higher proportion of induction of labor (44.2% vs 37.4%; P =.049) and preterm delivery at less than 37 weeks gestation (14.1% vs 8.1%; P <.001). There were no significant differences between the groups in primary cesarean delivery, neonate requiring intensive care unit (ICU) admission, postpartum hemorrhage, placental abruption, and preeclampsia.

However, propensity-score matching results differed from the primary analysis. In this analysis, a higher percentage of participants with vs without epilepsy had cesarean delivery (36.1% vs 28.2%; P =.021), but there were no differences in breastfeeding initiation. In addition, a higher percentage of those with vs without epilepsy had neonate requiring ICU admission (9.9% vs 5.4%; P =.018), but there were no differences in inductions of labor.

Multivariate logistic regression analysis indicated an association between epilepsy and increased risk for longer postpartum hospital stays (odds ratio [OR], 1.8; 95% CI, 1.0-3.1; P =.035). Factors associated with longer postpartum hospitalizations were greater maternal age (OR, 1.1; 95% CI, 1.0-1.1; P <.001), Hispanic/Latinx ethnicity (OR, 2.0; 95% CI, 1.3-3.0; P =.001), substance use behavior/disorder (OR, 3.6; 95% CI, 1.7-7.7; P =.001), cesarean delivery (OR, 126.4; 95% CI, 93.1-171.6; P <.001), preterm delivery (OR, 6.0; 95% CI, 3.9-9.1; P <.001), and Black race (P =.002).

Study limitations include a retrospective study design, lack of prenatal or preconception care data, and use of epilepsy diagnostic codes that excluded seizure and convulsion.

“After controlling for demographic and clinical characteristics, [patients with epilepsy] were more likely than [patients without epilepsy] to have cesarean deliveries, longer postpartum hospitalizations, preterm deliveries, and neonates requiring intensive care,” the researchers concluded.