Epilepsy is a neurological disorder that affects over 50 million people worldwide. Women with epilepsy often face unique challenges during pregnancy, including increased risk of seizures and potential harm to both mother and child. A recent large-scale meta-analysis has uncovered new evidence about the impact of epilepsy on perinatal outcomes. The study, which examined data from millions of pregnancies, provides important insights into the risks faced by women with epilepsy and highlights the need for better care and management during pregnancy. In this article, we will explore the main findings of the study and discuss its implications for clinical practice and public health.
A new study has shown that pregnant women with epilepsy have a higher risk of negative perinatal outcomes than those without epilepsy. The study, which included 76 articles and was published in JAMA Neurology, found that women with epilepsy had a 5-fold increase in the odds of maternal death compared to those without epilepsy. In addition, they had increased odds of gestational hypertension, preeclampsia, intrauterine growth restriction, miscarriage, preterm birth, induced labor, stillbirth, cesarean delivery, and neonatal and infant death. Neonates born to women with epilepsy also had increased odds of adverse outcomes, including low Apgar scores, NICU admission, small for gestational age, low birth weight, congenital conditions, and reduced birth weight, body length, head circumference, and gestational age.
The study also found that women with epilepsy who were taking antiseizure medications had higher odds of induced labor, NICU admission, small for gestational age, low birth weight, neonatal and infant death, and congenital conditions in their neonate. Polytherapy was associated with an increased odds of cesarean delivery, and neonates of women with epilepsy taking ASM polytherapy had increased odds of NICU admission, small for gestational age, and congenital conditions.
The study’s lead investigator advised clinicians to consider these findings when counseling pregnant women with epilepsy and those of childbearing age. The study supports the UK national guideline that women with epilepsy should receive pre-pregnancy counseling at the time of diagnosis and regularly during management, including preconception counseling on the risk of antiseizure medication use during pregnancy. They also recommend that advice about ASM use during pregnancy should come from an epilepsy specialist, and women with epilepsy during pregnancy and childbirth should follow a complex care pathway.
The study’s adjusted and unadjusted models for maternal, fetal, and neonatal outcomes showed slight differences. Specifically, the pooled adjusted meta-analysis indicated increased odds of preeclampsia, preterm birth, antepartum hemorrhage, small for gestational age, cesarean delivery, induced labor, maternal death, postpartum hemorrhage, and congenital conditions in offspring for women with epilepsy compared to those without epilepsy.
In conclusion, pregnant women with epilepsy have a higher risk of negative perinatal outcomes, and clinicians and women with epilepsy should consider the increased odds of adverse maternal and neonatal outcomes. Women with epilepsy should receive pre-pregnancy counseling at the time of diagnosis, and advice about antiseizure medication use during pregnancy should come from an epilepsy specialist. Women with epilepsy during pregnancy and childbirth should follow a complex care pathway.
In conclusion, the findings of this large-scale meta-analysis highlight the need for closer monitoring and specialized care of pregnant women with epilepsy. It is crucial for healthcare providers to identify and manage potential risk factors early on in order to prevent adverse perinatal outcomes. With further research, we can gain a better understanding of the specific mechanisms that contribute to these outcomes, and ultimately, work towards improving the health outcomes for both the mother and child.
