Differences in delivery type, breastfeeding initiation, and length of postpartum hospitalization in patients with epilepsy.

Objective: Patients with epilepsy (PWE) account for .3%-.5% of all births annually. PWE have higher obstetric health care utilization and lower rates of breastfeeding initiation, whereas data on cesarean delivery rates are mixed. The aim of this study was to examine the association of epilepsy with maternal outcomes, including the rate of cesarean delivery, rate of breastfeeding initiation, and length of postpartum hospitalization, in individuals delivering a singleton infant in a multihospital health care system on the East Coast.

Methods: We included patients aged 18-45 years who delivered a singleton infant between September 1, 2018 and May 31, 2023. We compared the following among PWE and patients without epilepsy (PWoE): cesarean deliveries, length of postpartum hospitalization, breastfeeding initiation, inductions of labor versus spontaneous labor, unlabored primary cesarean deliveries, preterm deliveries (gestational age < 37 weeks), neonatal disposition, postpartum hemorrhage, placental abruption, and preeclampsia. Antiseizure medications (ASMs) listed at the time of delivery hospitalization were also extracted. A sensitivity analysis of PWE who either used or did not use ASMs at the time of delivery evaluated whether ASM use affected the primary outcomes. Comparable subpopulations identified with propensity score matching (PSM) examined the effect of epilepsy on maternal outcomes. A multivariate logistic regression identified predictors of prolonged postpartum hospitalization.

Results: Of 33 764 deliveries, 199 (.59%) were to PWE. PWE had a higher proportion of cesarean delivery (36.1% vs. 28.2%), preterm delivery (15.0% vs. 8.4%), neonates requiring intensive care (9.9% vs. 5.4%), and prolonged postpartum hospitalization (33.3% vs. 22.1%) compared to PWoE (p ≤ .021) after PSM. A total of 54.8% (n = 109) of PWE used ASMs at the time of delivery compared to PWoE (n = 473, 1.4%). Epilepsy was associated with a higher risk of prolonged postpartum hospitalization (odds ratio = 1.8, 95% confidence interval = 1.0-3.1).

Significance: PWE had worse maternal outcomes than PWoE, and epilepsy itself was a risk factor for prolonged postpartum hospitalization. ASM use in PWE at the time of delivery was lower than expected.