Abstracts

Rationale: In pregnancy, stress leads to higher risks of pregnancy complications. Specifically, risks of miscarriage, preterm labor, low birth weight, and preeclampsia are elevated with increased maternal stress. For epilepsy patients, chronic stress has also been shown to increase seizure occurrence. Stress can be due to emotional, financial, environmental, relationship, work, or other factors. For women with epilepsy (WWE) who are pregnant, it is important for clinicians to address specific stressors and stress management. However, there have been no studies using population-level data evaluating the types and amount of stress pregnant WWE experience relative to pregnant women without epilepsy (WWoE).

Methods: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an annual survey of weighted, randomly sampled postpartum women administered by the Centers for Disease Control (CDC). We used data from the PRAMS from 2012-2019 to assess the life stressors reported by WWE compared to WWoE. We adjusted the data for maternal age, race, ethnicity, marital status, education, and socioeconomic status (SES; using income, WIC, and Medicaid use). We also examined reported abuse in WWE compared to WWoE.

Results: This study included data from 64,951 women, representing 4,072,189 postpartum women through weighted sampling. Of these, 1,140 reported having a diagnosis of epilepsy in the 3 months prior to their pregnancies (representing 81,021 women with epilepsy). WWE were less likely to be married and less likely to be of Hispanic ethnicity; however there were no statistically significant differences in age, educational status, and SES.

Women were asked about 14 life stressors in the year prior to their pregnancy. WWE experienced a higher number of stressors (2.48) compared to WWoE (1.72; p< 0.001). WWE were more likely to have experienced 9 of the 14 stressors: family illness, divorce, homelessness, partner losing a job, reduced work or pay, increased arguments, having a partner in jail, drug use, and the death of someone close to them.

After adjusting for demographics (age, race, and SES), epilepsy was associated with a higher number of stressors (with an average increase of 0.45 stressors) in WWE compared to WWoE (95% confidence interval 0.26-0.64, p< 0.001). Other factors associated with stressors were younger age, Indigenous or mixed race, non-Hispanic ethnicity, lower income, and WIC or Medicaid use. Those who were married were less likely to report stressors.

WWE were also more likely to report abuse before or during their pregnancies, with an adjusted odds ratio of 2.78 (95% CI 2.07-3.74) for reporting abuse.

Conclusions: While managing stress is important in both epilepsy and pregnancy, WWE experience more stressors than do WWoE. After adjusting for maternal age, race, and SES, this increase in stressors persisted. Women who were younger, with lower income, on WIC or Medicaid, or not married also were more likely to experience life stressors. Alarmingly, reported abuse was also higher in WWE compared to WWoE. More attention from clinicians and support services for WWE are needed to ensure better pregnancy outcomes.

Funding: Please list any funding that was received in support of this abstract.: None.