Women treated for epilepsy during pregnancy: outcomes from a nationwide population-based cohort study

Abstract

Introduction: Women with epilepsy (WWE) are generally treated as a risk group during pregnancy, but over 90% of pregnant WWE have favorable pregnancies. However, the risk of some pregnancy and delivery complications may be increased among WWE, especially those on antiepileptic drugs. Material and methods: This nationwide, retrospective population-based cohort study includes WWE who gave birth in Finland during 1987–2008 (n = 1737) and the reference cohort of a random sample of women without epilepsy (n = 4357). Identification of the cohorts, and information on hospitalizations and deliveries were obtained from the Finnish Health Registers and population statistics. Multivariate analyses were conducted by binomial regression. Results: WWE were more often hospitalized during pregnancy for accidents or other external causes [adjusted risk ratio (aRR) 1.74, 95% confidence interval (CI) 0.98–3.09], premature rupture of membranes (aRR 1.75, 95% CI 1.14–2.69) and premature contractions (aRR 1.75, 95% CI 1.36–2.23). Hospitalizations for infections were more frequent in WWE (1.4% vs. 0.4%, aRR 3.15, 95% CI 1.72–5.76). The risk for induction of delivery or a cesarean section was increased in WWE. There was no difference in premature deliveries between the groups, but the risk of being small for gestational age (aRR 1.57, 95% CI 1.23–2.01), admission to neonatal intensive care unit (aRR 1.66, 95% CI 1.39–1.97), and need for respiratory care (aRR 2.37, 95% CI 1.57–3.60) was clearly increased in the offspring of WWE. Conclusions: WWE are at an increased risk of complications and hospitalizations during pregnancy and delivery. However, the majority of WWE have a normal pregnancy and delivery.