Epilepsy in pregnancy: Nordic study highlights heightened risk of mortality for mothers
Groundbreaking research led by Karolinska Institutet reveals significantly elevated risks of mortality and morbidity for pregnant women with epilepsy and their babies, emphasising the need for specialised care throughout pregnancy and beyond.
Neda Razaz
Unprecedented scale of research
In a landmark study published in JAMA Neurology, researchers have shed light on the risks associated with epilepsy during pregnancy. The study, led by Karolinska Institutet, analysed data from over 4.5 million pregnancies across the five Nordic countries between 1997 and 2017, including more than 35,000 pregnancies where the mother had epilepsy.
This extensive dataset has allowed researchers to examine rare outcomes with unprecedented precision, offering crucial insights into a complex medical scenario that has long challenged clinicians.
Startling findings
The study’s findings are sobering: Women with epilepsy face a fourfold increase in mortality risk during pregnancy compared to those without the condition. Moreover, their infants have a 50% higher risk of illness or death in the first 42 days after birth.
Neda Razaz, associate professor of epidemiology and lead author of the study, emphasises the significance of these results: “The main findings are that women with epilepsy are four times more likely to die during pregnancy and that during the first 42 days after delivery, the children of women with epilepsy have a 50 percent higher risk of illness or death.”
While these relative risk figures are indeed alarming, Razaz is quick to provide context. The absolute numbers remain small, with the risk of maternal death increasing from 5 per 100,000 pregnancies to 23 per 100,000 pregnancies for women with epilepsy.
“96 percent of all women with epilepsy in our study had a completely uncomplicated pregnancy with a normal outcome. I don’t want our results to scare women away from having children,” Razaz clarifies.
The role of anti-epileptic drugs
The study also examined the impact of anti-epileptic drug treatment on pregnancy outcomes. Women treated with these medications, along with their babies, showed higher risks compared to those with epilepsy who were not on medication. However, this likely reflects the severity of the condition in those requiring pharmacological intervention.
Razaz notes: “For many women with epilepsy, stopping the drugs if they become pregnant is not an option.” This underscores the delicate balance clinicians must strike between managing epilepsy and minimising risks during pregnancy.
A call for specialised care
The researchers conclude that these risks can be mitigated through enhanced care before, during, and after pregnancy. Razaz advocates for a comprehensive approach: “Women with epilepsy should be treated at clinics with special expertise that can optimise their treatment even before they become pregnant. Then they should be specifically monitored both during and after pregnancy.”
This call for specialised care highlights the need for a multidisciplinary approach to managing epilepsy in pregnancy, involving neurologists, obstetricians, and neonatologists to ensure the best possible outcomes for both mother and child.
Implications for clinical practice
The findings of this study have significant implications for clinical practice. They underscore the importance of preconception counselling for women with epilepsy, careful medication management during pregnancy, and close monitoring of both mother and infant in the postpartum period.
Furthermore, the research emphasises the need for healthcare systems to ensure that women with epilepsy have access to specialised care throughout their reproductive years, not just during pregnancy.
While this study provides valuable insights, it also opens avenues for future research. Questions remain about the specific mechanisms underlying the increased risks and the most effective strategies for risk reduction. Further studies may also explore the long-term outcomes for children born to mothers with epilepsy and the potential impact of newer anti-epileptic medications.
This landmark Nordic study has quantified the risks associated with epilepsy in pregnancy with unprecedented precision. While the findings are concerning, they also provide a foundation for improved care and better outcomes for women with epilepsy and their children.
Reference:
- Razaz, N., Igland, J., Bjørk, M. H., et. al. (2024). Risk of perinatal and maternal morbidity and mortality among pregnant women with epilepsy. JAMA Neurology. Advance online publication. https://doi.org/10.1001/jamaneurol.2024.2375
