# Severe, uncontrolled epilepsy in pregnancy: A population-based case-control study

## TL;DR

Women with severe, uncontrolled epilepsy during pregnancy are more likely to be admitted for seizures and give birth early, highlighting the need for early specialist care and better pregnancy planning.

## Contribution

This study identifies risk factors and outcomes for women with severe, uncontrolled epilepsy during pregnancy using a population-based case-control design.

## Key findings

- Women with severe epilepsy were more likely to be hospitalized for seizures before pregnancy.
- Severe epilepsy during pregnancy was associated with a higher risk of preterm birth.
- Early specialist review is recommended for women with a history of seizure-related hospitalization.

## Abstract

Epilepsy affects one percent of the UK population and is the most common serious neurological condition experienced during pregnancy. We compared the characteristics, clinical management, and pregnancy outcomes in women with severe, uncontrolled epilepsy to those of women with well controlled disease.

We conducted a population-based case-control study in all UK consultant-led maternity units. Cases of severe uncontrolled epilepsy during pregnancy were identified prospectively and reported via the UK Obstetric Surveillance System (UKOSS). Severe epilepsy was defined
a-priori as ≥1 of the following: admission to hospital during pregnancy to manage seizures; prescribed ≥3 antiepileptic medications; or died from epilepsy. Controls comprised women with epilepsy not meeting the case definition, identified within the same centres as cases. Pre-pregnancy epilepsy control and pregnancy outcomes were compared between groups using multivariable logistic regression.

We identified 94 cases between 1 October 2015 and 31 March 2017 and compared these with 186 controls. Cases were significantly more likely to be admitted to manage seizures in the year preceding pregnancy (42/94 cases vs 10/186 controls, adjusted odds ratio [aOR]=7.38 [95% CI 2.70-20.2]), and to report their most recent seizure within 3 months of pregnancy (51/94 cases vs 18/186 controls, aOR=5.86 [95% CI 2.30-15.0]). Cases were significantly more likely to deliver before 37 weeks (20/94 cases vs 8/186 controls, aOR=7.61 [95% CI 2.87-20.2]).

Women admitted for seizure management in the year before pregnancy are at higher risk of severe epilepsy during pregnancy and of preterm birth. These women should be prioritised for discussion about pregnancy and contraception. When pregnant, they should be reviewed as early as possible by specialists in the management of epilepsy during pregnancy. Delivering messages about the importance of pregnancy planning and contraception to all women with epilepsy should be viewed as the responsibility of all clinicians involved their care.

Epilepsy is the most common serious neurological condition that women experience during pregnancy. We wanted to understand how women who have severe, uncontrolled epilepsy during pregnancy differ from those with well-controlled epilepsy. We also investigated whether these two groups received different clinical care during pregnancy, and how they and their babies fared during and after birth.

The UK Obstetric Surveillance System (UKOSS) gathers anonymous information from all UK maternity units about pregnant women with certain conditions. We used UKOSS to collect information about women with severe, uncontrolled epilepsy during pregnancy. The authors confirm that this collection of Information was approved by UKOSS and the London Multi-Centre Research Ethics Committee. We defined this group as pregnant women who:
-were prescribed three or more anti-epileptic medications, or-were admitted to hospital because of seizures, or-died of epilepsy.

were prescribed three or more anti-epileptic medications, or

were admitted to hospital because of seizures, or

died of epilepsy.

We compared these women with a group of pregnant women with epilepsy who did not meet any of these criteria.

The women with severe, uncontrolled epilepsy were more likely to have been admitted to hospital because of seizures in the year before they got pregnant. They were also more likely to have had their most recent seizure 3 months or less before they got pregnant. Women with severe, uncontrolled epilepsy were more likely than women with well-controlled epilepsy to give birth early, before 37 weeks; 20% of these early births were spontaneous, while 80% were recommended by clinicians.

Women with epilepsy who have been to hospital with a seizure in the year before getting pregnant are at greater risk of severe epilepsy during pregnancy and of giving birth early. These women should be seen by epilepsy specialists as a priority, as early as possible during pregnancy. All healthcare professionals caring for women of childbearing age with epilepsy should be aware that it is important to discuss contraception and pregnancy planning, particularly with non-pregnant women who come to hospital with seizures.