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Am J Perinatol 2024; 41(07): 935-943
DOI: 10.1055/a-1788-4791
Original Article

The Obstetrical Care and Delivery Experience of Women with Epilepsy in the MONEAD Study

Thomas F. McElrath
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Maurice Druzin
2   Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California
,
Linda J. Van Marter
3   Division of Newborn Medicine, Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
,
Ryan C. May
4   Emmes, Washington, District of Columbia
,
Carrie Brown
4   Emmes, Washington, District of Columbia
,
Alice Stek
5   Department of Obstetrics-Gynecology, University of Southern California, Los Angeles, California
,
William Grobman
6   Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Mary Dolan
7   Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia
,
Patricia Chang
8   Department of Obstetrics-Gynecology, Minnesota Epilepsy Group, St. Paul, Minnesota
,
Kellie Flood-Schaffer
9   Department of Obstetrics-Gynecology, University of Cincinnati, Cincinnati, Ohio
,
Lamar Parker
10   Department of Obstetrics-Gynecology, Wake Forest University, Winston-Salem, North Carolina
,
Kimford J. Meador
12   Department of Neurology, Stanford University, Standford, California
,
Page B. Pennell
11   Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
for the MONEAD Investigator Group › Institutsangaben Funding This study was supported by National Institute of Health (NIH), National Institute of Neurological Disorders and Stroke (NINDS), National Institute of Child Health and Human Development (NICHD), grant no.: U01-NS038455; consulting fees from Hoffman–LaRoache, Basel SW, and Service on scientific advisory board; and Momenta Pharmaceuticals, Inc. Cambridge, MA; Service on scientific advisory board. Cash payment and myasthenia gravis.
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Abstract

Objective We examined mode of delivery among pregnant women with epilepsy (PWWE) versus pregnant controls (PC). We hypothesize that PWWE are more likely to deliver by cesarean.

Study Design The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is an observational, prospective, multicenter investigation of pregnancy outcomes funded by the National Institute of Health (NIH). MONEAD enrolled patients from December 2012 through January 2016. PWWE were matched to PC in a case:control ratio of 3:1. This analysis had 80% power to detect a 36% increase in cesarean frequency assuming a baseline rate of 30% among PC at an α = 0.05.

Results This report analyzed 331 PWWE (76%) and 102 PC (24%) who gave birth while enrolled in the study. PWWE and PC had similar rates of cesarean delivery (34.7 vs. 28.6%; p = 0.27). Of women with cesarean, rates of cesarean without labor were similar between groups for those delivering in recruitment hospitals (48.2 vs. 50.0%) but in nonrecruitment hospitals, cesarean rates without labor were over two-fold higher among PWWE than those of PC (68.8 vs. 30.8%; p = 0.023). Receipt of a cesarean after labor did not differ for PWWE compared to PC or by type of antiepileptic drug among the PWWE.

Conclusion These findings suggest that the obstetrical experiences of PWWE and PC are similar. An interesting deviation from this observation was the mode of delivery with higher unlabored cesarean rates occurring among PWWE in nonrecruitment hospitals. As the study recruitment hospitals were tertiary academic centers and nonrecruitment hospitals tended to be community-based institutions, differences in perinatal expertise might contribute to this difference.

Key Points

  • Unlabored cesarean rates higher among women with epilepsy.

  • Provider preference may influence delivery mode among women with epilepsy.

  • Type and amount of antiepileptic drug was not associated with mode of delivery.

Keywords

cesarean - epilepsy - seizure - prenatal care

Supplementary Material



Publikationsverlauf

Eingereicht: 12. Juli 2021

Angenommen: 17. Februar 2022

Accepted Manuscript online:
04. März 2022

Artikel online veröffentlicht:
31. Dezember 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Zack MM, Kobau R. National and state estimates of the numbers of adults and children with active epilepsy - United States, 2015. MMWR Morb Mortal Wkly Rep 2017; 66 (31) 821-825
    CrossrefPubMedGoogle Scholar
  • 2 Edey S, Moran N, Nashef L. SUDEP and epilepsy-related mortality in pregnancy. Epilepsia 2014; 55 (07) e72-e74
    CrossrefPubMedGoogle Scholar
  • 3 MacDonald SC, Bateman BT, McElrath TF, Hernández-Díaz S. Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States. JAMA Neurol 2015; 72 (09) 981-988
    CrossrefPubMedGoogle Scholar
  • 4 Kapoor D, Wallace S. Trends in maternal deaths from epilepsy in the United Kingdom: a 30-year retrospective review. Obstet Med 2014; 7 (04) 160-164
    CrossrefPubMedGoogle Scholar
  • 5 Osterman MJK, Martin JA. Trends in low-risk cesarean delivery in the United States, 1990-2013. Natl Vital Stat Rep 2014; 63 (06) 1-16
    PubMedGoogle Scholar
  • 6 Osterman MJK, Martin JA. Primary cesarean delivery rates, by state: results from the revised birth certificate, 2006-2012. Natl Vital Stat Rep 2014; 63 (01) 1-11
    PubMedGoogle Scholar
  • 7 Menard MK, Main EK, Currigan SM. Executive summary of the reVITALize initiative: standardizing obstetric data definitions. Obstet Gynecol 2014; 124 (01) 150-153
    CrossrefPubMedGoogle Scholar
  • 8 Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol 2017; 129 (04) 603-607
    CrossrefPubMedGoogle Scholar
  • 9 St Louis EK. Monitoring antiepileptic drugs: a level-headed approach. Curr Neuropharmacol 2009; 7 (02) 115-119
    CrossrefPubMedGoogle Scholar
  • 10 Taylor J, Kolamunnage-Dona R, Marson AG, Smith PEM, Aldenkamp AP, Baker GA. SANAD study group. Patients with epilepsy: cognitively compromised before the start of antiepileptic drug treatment?. Epilepsia 2010; 51 (01) 48-56
    CrossrefPubMedGoogle Scholar
  • 11 Smith DB, Craft BR, Collins J, Mattson RH, Cramer JA. Behavioral characteristics of epilepsy patients compared with normal controls. Epilepsia 1986; 27 (06) 760-768
    CrossrefPubMedGoogle Scholar
  • 12 Witt JA, Helmstaedter C. Cognition in the early stages of adult epilepsy. Seizure 2015; 26: 65-68
    CrossrefPubMedGoogle Scholar
  • 13 Minagar A. ed. Neurological Disorders and Pregnancy. 1st ed. Burlington, MA: Elsevier Inc; 2011
    Google Scholar
  • 14 Farmen AH, Grundt JH, Nakling JO, Mowinckel P, Nakken KO, Lossius MI. Increased rate of acute caesarean sections in women with epilepsy: results from the Oppland Perinatal Database in Norway. Eur J Neurol 2019; 26 (04) 617-623
    CrossrefPubMedGoogle Scholar
  • 15 Razaz N, Tomson T, Wikström A-K, Cnattingius S. Association between pregnancy and perinatal outcomes among women with epilepsy. JAMA Neurol 2017; 74 (08) 983-991
    CrossrefPubMedGoogle Scholar
  • 16 Vajda FJE, O'Brien TJ, Graham JE. et al. Cesarean section in Australian women with epilepsy. Epilepsy Behav 2018; 89: 126-129
    CrossrefPubMedGoogle Scholar
  • 17 Salem HA, Al-Shorbagy MY. Evaluation of the relaxant effect of levetiracetam on isolated rat duodenum. Fundam Clin Pharmacol 2017; 31 (01) 75-82
    CrossrefPubMedGoogle Scholar
  • 18 Jankovic SMSV, Jankovic SV, Kostic J, Kostic I, Jakovljevic M. Inhibitory effects of selected antiepileptics on spontaneous motility of isolated human oviducts. Eur J Clin Pharmacol 2006; 62 (09) 707-712
    CrossrefPubMedGoogle Scholar
  • 19 Teramo K, Hiilesmaa V, Bardy A, Saarikoski S. Fetal heart rate during a maternal grand mal epileptic seizure. J Perinat Med 1979; 7 (01) 3-6
    CrossrefPubMedGoogle Scholar