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

Thomas F. McElrath; Maurice Druzin; Linda J. Van Marter; Ryan C. May; Carrie Brown; Alice Stek; William Grobman; Mary Dolan; Patricia Chang; Kellie Flood-Schaffer; Lamar Parker; Kimford J. Meador; Page B. Pennell; for the MONEAD Investigator Group

doi:10.1055/a-1788-4791

American Journal of Perinatology, Table of Contents

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

Authors

Thomas F. McElrath

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Maurice Druzin

²Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California
Linda J. Van Marter

³Division of Newborn Medicine, Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
Ryan C. May

⁴Emmes, Washington, District of Columbia
Carrie Brown

⁴Emmes, Washington, District of Columbia
Alice Stek

⁵Department of Obstetrics-Gynecology, University of Southern California, Los Angeles, California
William Grobman

⁶Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
Mary Dolan

⁷Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia
Patricia Chang

⁸Department of Obstetrics-Gynecology, Minnesota Epilepsy Group, St. Paul, Minnesota
Kellie Flood-Schaffer

⁹Department of Obstetrics-Gynecology, University of Cincinnati, Cincinnati, Ohio
Lamar Parker

¹⁰Department of Obstetrics-Gynecology, Wake Forest University, Winston-Salem, North Carolina
Kimford J. Meador

¹²Department of Neurology, Stanford University, Standford, California
Page B. Pennell

¹¹Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

for the MONEAD Investigator Group

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

Full Text

References

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