Delivery of care, anti-seizure medication adherence and factors affecting seizure outcomes in women with epilepsy during pregnancy: a retrospective cohort study

Abstract

Objective

The rate of maternal mortality and obstetric complications amongst women with epilepsy during pregnancy is higher than that of the general population. The reason for this remains unclear but poor access to epilepsy specialist in a timely manner, poor medication adherence and falling levels of ASM are often stated within the published literature. We aim to explore whether this assumption is correct and consider the influence that clinical and epidemiological factors have on outcomes.

Methods

Pregnant women with epilepsy were identified between January 2015 and June 2022 from the local obstetric register. Key clinical features were identified following a manual review of patient records. Demographic information, scheduled and unscheduled secondary care contact, maternity care and medication dispensing history were obtained from routinely collected health datasets. An adverse outcome was defined as a reported seizure or epilepsy-related hospital contact during pregnancy or within 12-weeks postpartum.

Results

We identified 458 pregnancies from 336 WWE. An adverse epilepsy related outcome was observed in 212/458 (46%) pregnancies. Review during the pre-booking period was noted in 189/458 (41.2%) cases and during pregnancy in 302/458 (65.9%). The most common ASM monotherapy was levetiracetam (LVT)(152/285 pregnancies, 53.3%) followed by lamotrigine (LTG) (110/285 pregnancies, 38.6%). Overall, exposure to polytherapy, LTG exposure, a seizure during the preconception period and low socioeconomic status were associated with an adverse outcome.

Conclusion

An epilepsy related admission or reported seizure was commonly experienced in WWE during pregnancy and in a small proportion of women this came after a period of seizure freedom. There is much work to be done to improve outcomes in women with epilepsy during pregnancy and the low rates of pre-conception care remain a concern. Routine preconception care would potentially allow complex issues such as ASM adherence, potential falling levels of ASM in pregnancy, driving and teratogenicity to be considered. Although seizure freedom is not possible for a significant proportion of women (both during the preconception period and pregnancy) early review in the preconception period and throughout pregnancy is likely to ensure epilepsy control is optimum and all potentially modifiable factors are considered.