[ARTICLE] Mortality and Morbidity During Delivery Hospitalization Among Pregnant Women With Epilepsy in the United States – Full Text HTML

ABSTRACT

Importance  Between 0.3% and 0.5% of all pregnancies occur among women with epilepsy. Evidence suggests an increase in perinatal morbidity and mortality among women with epilepsy. However, these risks have not been quantified in large population-based samples.

Objective  To report on the risk for death and adverse outcomes at the time of delivery for women with epilepsy in the United States.

Design, Setting, and Participants  Retrospective cohort study of pregnant women identified through delivery hospitalization records from the 2007-2011 Nationwide Inpatient Sample. From this representative sample of 20% of all US hospitals, we obtained a weighted sample of delivery hospitalizations from 69 385 women with epilepsy and 20 449 532 women without epilepsy.

Main Outcomes and Measures  Obstetrical outcomes including maternal death, cesarean delivery, length of stay, preeclampsia, preterm labor, and stillbirth.

Results  Women with epilepsy had a risk of death during delivery hospitalization of 80 deaths per 100 000 pregnancies, significantly higher than the 6 deaths per 100 000 pregnancies found among women without epilepsy (adjusted odds ratio [OR], 11.46 [95% CI, 8.64-15.19]). Women with epilepsy were also at a heightened risk for other adverse outcomes, including preeclampsia (adjusted OR, 1.59 [95% CI, 1.54-1.63]), preterm labor (adjusted OR, 1.54 [95% CI, 1.50-1.57]), and stillbirth (adjusted OR, 1.27 [95% CI, 1.17-1.38]), and had increased health care utilization, including an increased risk of cesarean delivery (adjusted OR, 1.40 [95% CI, 1.38-1.42]) and prolonged length of hospital stay (>6 days) among both women with cesarean deliveries (adjusted OR, 2.13 [95% CI, 2.03-2.23]) and women with vaginal deliveries (adjusted OR, 2.60 [95% CI, 2.41-2.80]).

Conclusions and Relevance  Findings suggest that women with epilepsy are at considerably heightened risk for many adverse outcomes during their delivery hospitalization, including a more than 10-fold increased risk of death, and that increased clinical attention is imperative for these pregnancies.

Full Text HTML —>  JAMA Network | JAMA Neurology | Mortality and Morbidity During Delivery Hospitalization Among Pregnant Women With Epilepsy in the United States.

Detect language Afrikaans Albanian Arabic Armenian Azerbaijani Basque Belarusian Bengali Bosnian Bulgarian Cebuano Catalan Chichewa Chinese (Simplified) Chinese (Traditional) Croatian Czech Danish Dutch English Esperanto Estonian Filipino Finnish French Galician Georgian German Greek Gujarati Haitian Creole Hausa Hebrew Hindi Hmong Hungarian Icelandic Igbo Indonesian Irish Italian Japanese Javanese Kazakh Kannada Khmer Korean Lao Latin Latvian Lithuanian Macedonian Malagasy Malay Malayalam Maltese Maori Marathi Mongolian Myanmar (Burmese) Nepali Norwegian Persian Polish Portuguese Romanian Punjabi Russian Serbian Sesotho Sinhala Slovak Slovenian Somali Spanish Sundanese Swahili Swedish Tajik Tamil Telugu Thai Turkish Ukrainian Urdu Uzbek Vietnamese Welsh Yiddish Yoruba Zulu

Afrikaans Albanian Arabic Armenian Azerbaijani Basque Belarusian Bengali Bosnian Bulgarian Cebuano Catalan Chichewa Chinese (Simplified) Chinese (Traditional) Croatian Czech Danish Dutch English Esperanto Estonian Filipino Finnish French Galician Georgian German Greek Gujarati Haitian Creole Hausa Hebrew Hindi Hmong Hungarian Icelandic Igbo Indonesian Irish Italian Japanese Javanese Kazakh Kannada Khmer Korean Lao Latin Latvian Lithuanian Macedonian Malagasy Malay Malayalam Maltese Maori Marathi Mongolian Myanmar (Burmese) Nepali Norwegian Persian Polish Portuguese Romanian Punjabi Russian Serbian Sesotho Sinhala Slovak Slovenian Somali Spanish Sundanese Swahili Swedish Tajik Tamil Telugu Thai Turkish Ukrainian Urdu Uzbek Vietnamese Welsh Yiddish Yoruba Zulu

Text-to-speech function is limited to 100 characters

Options : History : Help : Feedback

[WEB SITE] Childbearing Risky in Women With Epilepsy

NEW YORK (Reuters Health) – Pregnant women with epilepsy are at increased risk of suffering serious complications or dying during delivery, a new study finds.

Less than 1% of all pregnancies occur in women with epilepsy, but data are lacking on how these women fare.

Using the National Inpatient Sample, Sarah C. MacDonald, of the Harvard T.H. Chan School of Public Health in Boston, and colleagues created a weighted sample of 69,385 women with epilepsy and about 20.4 million women without epilepsy who delivered a baby.

The maternal death rate was 80 per 100,000 pregnancies in women with epilepsy, compared with six per 100,000 in women without epilepsy, yielding an adjusted odds ratio of 11.46, the authors report.

Women with epilepsy were also at increased risk for preeclampsia (adjusted odds ratio 1.59), preterm labor (aOR 1.54) and stillbirth (aOR 1.27), and they were more apt to have cesarean delivery (aOR 1.40) and prolonged hospital stay (more than six days) regardless of whether they had a vaginal or cesarean delivery.

These findings suggest that “increased clinical attention is imperative” in pregnancies complicated by epilepsy, the authors say in their July 6 online paper in JAMA Neurology.

The authors caution that they didn’t have information on the ultimate causes of death during delivery among women with epilepsy, a key limitation. They say more study is needed to determine the exact causes of death and how interventions might improve outcomes.

In a JAMA Neurology podcast, Dr. Thomas McElrath of Brigham and Women’s Hospital, Boston, who worked on the study, said studies are needed to confirm these observations “and look at what may be going on in terms of a mechanism.”

Continue —>  Childbearing Risky in Women With Epilepsy.