Unplanned Pregnancy in Women With Epilepsy Increases Risk for Spontaneous Fetal Loss

According to a retrospective study of patients in The Epilepsy Birth Control Registry, unplanned pregnancy in women with epilepsy is associated with an increased risk for spontaneous fetal loss (SFL). Pregnancy planning, maternal age, and interpregnancy interval represent potential modifiable variables associated with this risk. The findings from this study were published in a recent edition of JAMA Neurology.

The Epilepsy Birth Control Registry, a web-based survey that retrospectively collects demographic, contraceptive use, epilepsy, folic acid use, and reproductive data from women with epilepsy, was used for this analysis. A total of 1144 women with epilepsy between 18 to 47 years of age (mean [SD] age, 28.5 [6.8] years) were surveyed between March 2018 and May 2018 and included in the final analysis. Investigators assessed the effect of unplanned vs planned pregnancies in this patient population on the risk for SFL. Additionally, the researchers assessed the potential for modifiable variables, including pregnancy spacing and antiepileptic drug (AED) category, on SFL vs live birth.

A total of 530 and 264 of 794 pregnancies were unplanned and planned, respectively. In 653 unaborted pregnancies among epileptic women, the risk of SFL was significantly greater in unplanned vs planned pregnancies (35% vs 16.4%, respectively; risk ratio [RR] 2.14; 95% CI, 1.59-2.90; P <.001). In the regression analysis, the risk of SFL was also significantly greater when researchers adjusted for interpregnancy interval, maternal age, and AED category (odds ratio [OR]3.57; 95% CI, 1.54-8.78; P =.003).

Potentially modifiable factors were also associated with SFL, including maternal age (OR 0.957; 95% CI, 0.928-0.986; P =.02) and interpregnancy interval (OR 2.878; 95% CI, 1.8094-4.5801; P =.008). When the interpregnancy interval was <1 year, the risk for SFL was significantly greater compared with an interval >1 year (45.9% vs 22.8%, respectively; RR 2.02; 95% CI, 1.49-2.72; P <.001). The risk for SFL was also greater among women aged 18-27 years (29.5%; RR 0.57; 95% CI, 0.39-0.84; P <.004) and 28-37 years (20.8%; RR 0.40; 95% CI, 0.26-0.62; P <.001) compared with women <18 years.

The lack of medical record verification of the included survey data as well as the relatively small proportion of minorities included in the study cohort represent potential limitations of this analysis.

“In view of the finding of increased risk for SFL in unplanned pregnancies in women with epilepsy, and because a history of SFL in women with epilepsy may increase the risk that subsequent live-born offspring will develop epilepsy,” the researchers concluded, “the finding warrants prospective investigation with medical record verification of pregnancy outcomes.”

Reference

Herzog AG, Mandle HB, MacEachern DB. Association of unintended pregnancy with spontaneous fetal loss in women with epilepsy: findings of the Epilepsy Birth Control Registry [published online October 15, 2018]. JAMA Neurol. doi: 10.1001/jamaneurol.2018.3089