Is Eclampsia in Pregnancy Linked with Greater Risk for Seizure Disorder?
BACKGROUND AND PURPOSE:
Smaller studies have suggested that eclampsia may be associated with future seizure disorder related to cortical injury
Nerenberg et al. (Obstetrics and Gynecology, 2017) evaluated the incidence rate and relative risk of seizure disorder following eclampsia
Retrospective population-based cohort study
Maternal Eclampsia and Long-Term Seizure study (2002 – 2014)
Inclusion: women 15-50 years
Exclusion: women with epilepsy, conditions predisposing to seizure, and those who died within 30 days of the delivery discharge date
Primary Exposure: Defined as eclampsia, preeclampsia, or gestational hypertension between 20 completed weeks of gestation and 30 days after birth
Referent Group: Women with no hypertensive disorders of pregnancy
Primary outcome was the risk of seizure disorder starting >30 days after index birth discharge and not more than 20 weeks into a subsequent pregnancy
Risk was expressed as an incidence rate and a hazard ratio (HR) with 95% CI
Multivariable adjustment performed for confounders at the index birth as well as adjusting for traumatic brain injury, stroke, cerebral tumor, aneurysm or hemorrhage, and multiple sclerosis
Total of 1,565,733 births were in the final cohort
1,615 (0.10%) pregnancies exclusively affected by eclampsia, 17,264 (1.1%) with preeclampsia, 60,863 (3.9%) with gestational hypertension, and 1,485,991 (94.9%) unaffected
Risk for a future seizure disorder was significantly higher after a pregnancy with eclampsia (4.58/10,000 person-years), compared to a pregnancy without a hypertensive disorder of pregnancy (0.72/10,000 person-years)
Crude HR 6.09, 95% CI 2.73–13.60
Adjusted HR 5.42 95%, CI 2.42–12.12
The risk of seizure disorder was doubled in pregnancies affected by preeclampsia
Adjusted HR 1.96, 95%, CI 1.21–3.17)
No association was found in gestational hypertension
Adjusted HR 1.01, 95% CI 0.71–1.43
Authors observed an approximately six times higher risk of a future seizure disorder following eclampsia although the absolute risk is still very small
Mechanism unknown, but possibly related to cerebral edema leading to permanent cortical injury
Would explain why risk was higher in eclampsia than preeclampsia but absent in women with gestational hypertension where endothelial dysfunction is minimal
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