• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

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

image_pdfFavoriteLoadingFavorite

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

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

ObGFirst® – Try It Free! »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

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?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site