Is epilepsy associated with worse maternal and/or infant outcomes?
This meta-analysis of 76 observational studies found that women with epilepsy have worse maternal and neonatal outcomes than women without epilepsy. This was true whether or not epilepsy was treated with an ASM. Taking an ASM was associated with worse neonatal outcomes than not taking. Polytherapy was associated with worse neonatal outcomes than monotherapy. The authors recommend co-management of these patients with an epilepsy specialist for counseling and medication optimization.
These authors reported the results of their meta-analysis of observational studies to assess maternal and neonatal outcomes of women with epilepsy compared with those without (control patients). The authors included 45 retrospective cohorts, 21 prospective cohorts, 9 case-control study, and 1 cross-sectional study. Comparison of the epilepsy group with the control group showed an association of epilepsy with increased odds of gestational hypertension, preeclampsia, intrauterine growth restriction, miscarriage, preterm birth, stillbirth, cesarean delivery, maternal death, and neonatal reduced mean birthweight and gestational age. The authors compared outcomes for patients with epilepsy who were not taking antiseizure medications (ASMs) with the control patients and found associations for increased odds of cesarean delivery, preterm birth, intrauterine growth restriction, pregnancy loss, preeclampsia, and placental abruption with not taking ASM. They compared patients with epilepsy who were taking an ASM with those who were not and found those taking an ASM has increased odds of neonatal intensive care (NICU) admission, small-for-gestational-age infants, neonatal and infant death, and congenital conditions. They compared polytherapy with monotherapy and found polytherapy associated with increased odds of NICU admissions, small-for-gestational-age infants, birthweights less than 2500 grams, neonatal and infant death, and congenital conditions.
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo