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Association of Epilepsy and Severe Maternal Morbidity. | LitMetric

Association of Epilepsy and Severe Maternal Morbidity.

Obstet Gynecol

Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, the Division of Neonatal and Developmental Medicine, Department of Pediatrics, and the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Published: November 2021

Objective: To evaluate severe maternal morbidity (SMM) among patients with epilepsy and patients without epilepsy.

Methods: We retrospectively examined SMM using linked birth certificate and maternal hospital discharge records in California between 2007 and 2012. Epilepsy present at delivery admission was the exposure and was subtyped into generalized, focal and other less specified, or unspecified. The outcomes were SMM and nontransfusion SMM from delivery up to 42 days' postpartum, identified using Centers for Disease Control and Prevention indicators. Multivariable logistic regression models were used to adjust for confounders, which were selected a priori. We also estimated the association between epilepsy and SMM independent of comorbidities by using a validated obstetric comorbidity score. Severe maternal morbidity indicators were then compared using the same multivariable logistic regression models.

Results: Of 2,668,442 births, 8,145 (0.3%) were to patients with epilepsy; 637 (7.8%) had generalized, 6,250 (76.7%) had focal or other less specified, and 1,258 (15.4%) had unspecified subtypes. Compared with patients without epilepsy, patients with epilepsy had greater odds of SMM (4.3% vs 1.4%, adjusted odds ratio [aOR] 2.91, 95% CI 2.61-3.24) and nontransfusion SMM (2.9% vs 0.7%, aOR 4.16, 95% CI 3.65-4.75). Epilepsy remained significantly associated with increased SMM and nontransfusion SMM after additional adjustment for the obstetric comorbidity score, though the effects were attenuated. When grouped by organ system, all SMM indicators were significantly more common among patients with epilepsy-most notably those related to hemorrhage and transfusion.

Conclusion: Severe maternal morbidity was significantly increased in patients with epilepsy, and SMM indicators across all organ systems contributed to this.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542621PMC
http://dx.doi.org/10.1097/AOG.0000000000004562DOI Listing

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