BACKGROUND AND PURPOSE:

• The natural course of maternal epilepsy and its relationship to pregnancy is not well understood due to lack of nonpregnant comparator cohorts
• Pennell et al. (NEJM, 2020) compared seizure frequency and antiepileptic medication dosing in pregnant vs nonpregnant women

METHODS:

• Prospective, observational, multicenter cohort study (From December 2012 through January 2016)
  • Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study
  • 20 epilepsy centers
• Participants
  • Women with epilepsy
• Epochs
  • Pregnancy
    • Epoch 1: Pregnancy through peripartum period (first 6 weeks after birth)
    • Epoch 2: Postpartum period (through 7.5 months after birth)
  • Nonpregnant women
    • Epoch 1: Form enrollment through 10.5 months
    • Epoch 2:  Following 7.5 months
• Study design
  • Frequency of seizures in epoch 1 compared with frequency in epoch 2, with nonpregnant women as controls
  • Alteration in antiepileptic drug dosing also compared during epoch 1
• Primary outcome: Percentage of women who had a higher frequency of seizures that impaired awareness during epoch 1 than during epoch 2

RESULTS:

• 351 pregnant women with epilepsy | 109 nonpregnant controls
• History of seizures that impaired awareness
  • Pregnant women: 299 women
  • Controls: 93 women
• There was no difference between the percent of pregnant women who experienced increased seizure frequency in epoch 1 vs epoch 2 when compared to nonpregnant women
  • Pregnant women: 23%
  • Nonpregnant controls: 25%
  • Odds ratio (OR) 0.93 (95% CI, 0.54 to 1.60)
  • Nor were changes seen by stage of pregnancy
• During pregnancy, the dose of an antiepileptic drug was changed at least once in
  • 74% of pregnant women
  • 31% of controls
  • OR 6.36 (95% CI, 3.82 to 10.59)
• Absence of seizures during the 9 months before pregnancy was associated with remaining seizure-free during pregnancy
  • OR of remaining seizure-free: 0.22 (95% CI, 0.12 to 0.41)
• The dose of an antiepileptic drug was increased by end pregnancy in 70% of pregnant women vs 24% of controls
  •  OR 7.49 (95% CI, 4.37 to 12.84)

CONCLUSION:

• Approximately one quarter of pregnant women with epilepsy experienced a higher frequency of seizures during pregnancy compared to the postpartum period
  • However, the incidence of this trend was similar in nonpregnant women over a similar time frame
• Antiepileptic medication was more likely to be increased during pregnancy

Learn More – Primary Sources:

Changes in Seizure Frequency and Antiepileptic Therapy during Pregnancy

Related ObG Topics:

Adverse Perinatal Outcomes and Epilepsy: Is it the Disorder or the Treatment?

Antiepileptic Medications and Risk for Congenital Malformations

Breastfeeding Mothers Taking Antiepileptic Drugs – Is it Safe for Infants?