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Am J Perinatol 2024; 41(07): 935-943
DOI: 10.1055/a-1788-4791
Original Article

The Obstetrical Care and Delivery Experience of Women with Epilepsy in the MONEAD Study

Thomas F. McElrath
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Maurice Druzin
2   Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California
,
Linda J. Van Marter
3   Division of Newborn Medicine, Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
,
Ryan C. May
4   Emmes, Washington, District of Columbia
,
Carrie Brown
4   Emmes, Washington, District of Columbia
,
Alice Stek
5   Department of Obstetrics-Gynecology, University of Southern California, Los Angeles, California
,
William Grobman
6   Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Mary Dolan
7   Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia
,
Patricia Chang
8   Department of Obstetrics-Gynecology, Minnesota Epilepsy Group, St. Paul, Minnesota
,
Kellie Flood-Schaffer
9   Department of Obstetrics-Gynecology, University of Cincinnati, Cincinnati, Ohio
,
Lamar Parker
10   Department of Obstetrics-Gynecology, Wake Forest University, Winston-Salem, North Carolina
,
Kimford J. Meador
12   Department of Neurology, Stanford University, Standford, California
,
Page B. Pennell
11   Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
for the MONEAD Investigator Group › Author Affiliations Funding This study was supported by National Institute of Health (NIH), National Institute of Neurological Disorders and Stroke (NINDS), National Institute of Child Health and Human Development (NICHD), grant no.: U01-NS038455; consulting fees from Hoffman–LaRoache, Basel SW, and Service on scientific advisory board; and Momenta Pharmaceuticals, Inc. Cambridge, MA; Service on scientific advisory board. Cash payment and myasthenia gravis.
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Abstract

Objective We examined mode of delivery among pregnant women with epilepsy (PWWE) versus pregnant controls (PC). We hypothesize that PWWE are more likely to deliver by cesarean.

Study Design The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is an observational, prospective, multicenter investigation of pregnancy outcomes funded by the National Institute of Health (NIH). MONEAD enrolled patients from December 2012 through January 2016. PWWE were matched to PC in a case:control ratio of 3:1. This analysis had 80% power to detect a 36% increase in cesarean frequency assuming a baseline rate of 30% among PC at an α = 0.05.

Results This report analyzed 331 PWWE (76%) and 102 PC (24%) who gave birth while enrolled in the study. PWWE and PC had similar rates of cesarean delivery (34.7 vs. 28.6%; p = 0.27). Of women with cesarean, rates of cesarean without labor were similar between groups for those delivering in recruitment hospitals (48.2 vs. 50.0%) but in nonrecruitment hospitals, cesarean rates without labor were over two-fold higher among PWWE than those of PC (68.8 vs. 30.8%; p = 0.023). Receipt of a cesarean after labor did not differ for PWWE compared to PC or by type of antiepileptic drug among the PWWE.

Conclusion These findings suggest that the obstetrical experiences of PWWE and PC are similar. An interesting deviation from this observation was the mode of delivery with higher unlabored cesarean rates occurring among PWWE in nonrecruitment hospitals. As the study recruitment hospitals were tertiary academic centers and nonrecruitment hospitals tended to be community-based institutions, differences in perinatal expertise might contribute to this difference.

Key Points

  • Unlabored cesarean rates higher among women with epilepsy.

  • Provider preference may influence delivery mode among women with epilepsy.

  • Type and amount of antiepileptic drug was not associated with mode of delivery.

Keywords

cesarean - epilepsy - seizure - prenatal care

Supplementary Material



Publication History

Received: 12 July 2021

Accepted: 17 February 2022

Accepted Manuscript online:
04 March 2022

Article published online:
31 December 2022

© 2022. Thieme. All rights reserved.

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