More than half of all pregnancies in women with epilepsy (WWE) are unintended, despite that planning for pregnancy is of utmost importance in this population. It is likely that both maternal age and socioeconomic status contribute to the higher rates of pregnancy in WWE compared with women without epilepsy (WWoE), according to the results of a retrospective analysis that used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) — an annual survey of randomly sampled postpartum women that is administered by the Centers for Disease Control and Prevention. Findings from the current analysis were published in Neurology.
The investigators sought to compare the proportions of unintended pregnancies, prenatal vitamin or folic acid (PNVF) use, breastfeeding, and adequate prenatal care visits among WWE vs WWoE — all considered the primary outcomes. They used PRAMS data from 13 states compiled between 2009 and 2014 to compare primary outcomes among WWE and WWoE, along with secondary outcomes that included contraception practices, time to recognition of pregnancy, and outcomes in newborns. Adjustments were made based on maternal age, race/ethnicity, and socioeconomic status.
A total of 73,619 women were involved in the analysis, with 541 of them (0.7%) reporting epilepsy, which represented 3,442,128 WWoE and 26,635 WWE through weighted sampling. Overall, 55% of pregnancies among WWE were unintended, compared with 48% among WWoE. Following adjustment for covariates, epilepsy was not shown to be associated with unintended pregnancy or with inadequate prenatal care.
Although WWE were less likely to report breastfeeding compared with WWoE (69.1% vs 84.6%, respectively; odds ratio [OR] 0.40; 95% CI, 0.30-0.55; P <.001), they were significantly more likely than WWoE to report daily use of PNVF prior to conception (OR 2.03; 95% CI, 1.31-3.13; P =.002).
Univariate analysis demonstrated that epilepsy was associated with significantly higher rates of premature birth (<37 weeks; P <.001), neonatal intensive care unit stays (P <.001), and small for gestational age weight babies (<10th percentile for age; P <.001). Multivariate analysis also showed that epilepsy was associated with a higher risk for prematurity (adjusted OR 1.63; 95% CI, 1.23-2.16), although not with small for gestational age or neonatal intensive care unit stay after adjustment for prematurity.
The investigators concluded that prospective studies of WWE are warranted to determine more accurate rates of unintended pregnancies, PNVF use, prenatal care, breastfeeding, and neonatal outcomes. Effective education on the importance of pregnancy planning and folic acid use, as well as the risks associated with unintentional pregnancy, is needed, particularly in high-risk groups.
Johnson EL, Burke AE, Wang A, Pennell PB. Unintended pregnancy, prenatal care, newborn outcomes, and breastfeeding in women with epilepsy. Neurology. 2018;91:e1031-e1039.