Women With Epilepsy At Much High Risk Of Death During Delivery

MedicalResearch.com Interview with:
Sarah C. MacDonald, BS
Harvard T. H. Chan School of Public Health

MedicalResearch: What is the background for this study? What are the main findings?Response: Approximately 0.3-0.5% of all pregnancies are in women with epilepsy. While individual studies have suggested that women with epilepsy may be at increased risk for certain adverse outcomes in pregnancy, the risks have not been well quantified in large population based samples. We addressed this issue using a large retrospective sample of delivery hospitalizations from across the United States.The main findings were that women with epilepsy had a more than 10 fold increased risk of death during their delivery hospitalization as compared to the risk in women without epilepsy (80 deaths per 100,000 women with epilepsy vs. 6 deaths per 100,000 in women without epilepsy). We also found that women with epilepsy were at increased risk for a cesarean delivery, prolonged hospital stay, preeclampsia, preterm labor, stillbirth and other adverse outcomes.

MedicalResearch: What should clinicians and patients take away from your report?

Response: The findings from our work suggest that women with epilepsy are at a higher risk for many adverse outcomes during their delivery admission in hospital. While this is only one study, our work suggests that pregnancies in women with epilepsy may be high risk and that these patients may be best treated by physicians who are comfortable caring for these complex patients. While the relative risk of death in women with epilepsy was quite high, it is important to note that maternal death during delivery is still very rare, with only approximately 80 deaths for every 100,000 women with epilepsy.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Response: Our study was not designed to determine particular causes for the increased risks in women with epilepsy. Therefore further research is needed to understand why women with epilepsy are at a higher risk for adverse outcomes during delivery. Future research is also needed to determine the benefits of particular interventions. One possible route of improvement could be in triaging women with epilepsy to higher risk centers and following them closely throughout gestation and post-delivery.

Citation:

MacDonald SC, et al “Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States” JAMA Neurology 2015; DOI: 10.1001/jamaneurol.2015.1017

Sarah C. MacDonald, BSHarvard T. H. Chan School of Public Health (2015). Women With Epilepsy At Much High Risk Of Death During Delivery

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