Grand Rounds

Data from the MONEAD Study: Do Women with Epilepsy Experience More Seizures During Pregnancy?

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

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

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)

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

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