Women with epilepsy face a nearly fourfold increased risk of maternal death during pregnancy and postpartum compared to those without epilepsy, according to a recent multinational study.

The study, published in JAMA Neurology, analyzed data from 4.5 million pregnancies in women across Denmark, Finland, Iceland, Norway, and Sweden from 1996 to 2017, focusing on severe maternal and perinatal outcomes.

The average age at delivery for women in the epilepsy group was 29.9 years. Out of 35,283 deliveries to women with epilepsy, 46%, or 16,240, involved exposure to antiseizure medications during pregnancy.

Key Findings

Women with epilepsy had a higher risk of severe maternal morbidity and mortality compared to those without epilepsy. The adjusted odds ratio (aOR) for maternal death was 3.86 (95% confidence interval [CI] = 1.48-8.10).

Epilepsy was associated with increased odds of severe preeclampsia, embolism, cerebrovascular events, and severe mental health conditions.

Offspring of women with epilepsy had higher risks of mortality (aOR = 1.20; 95% CI = 1.05-1.38) and severe neonatal morbidity (aOR = 1.48; 95% CI = 1.40-1.56), including neonatal convulsions and respiratory distress syndrome.

Use of antiseizure medication during pregnancy was associated with higher risks of adverse outcomes. Women taking these agents had increased odds of severe maternal morbidity (aOR = 1.24; 95% CI = 1.10-1.48), and their neonates had increased odds of mortality and severe morbidity (aOR = 1.37; 95% CI = 1.23-1.52).

The incidence of severe maternal morbidity was higher in women with epilepsy, occurring in 36.9 out of 1,000 deliveries compared to 25.4 out of 1,000 deliveries in women without epilepsy. Increased likelihood of complications was noted, including severe preeclampsia (aOR = 1.30; 95% CI = 1.19-1.42), embolism (aOR = 1.42; 95% CI = 1.05-1.93), and cerebrovascular events (aOR = 5.81; 95% CI = 4.27-7.89).

While most pregnancies in women with epilepsy are uncomplicated, these findings suggest the benefit of enhanced counseling, perinatal support, and access to specialized care, wrote the study authors. 

Full disclosures can be found in the published study.