Abstracts

Rationale: Little is known about obstetrical and neonatal outcomes in women with epilepsy [WWE] taking AEDs. The AAN guidelines stated that a moderately increased risk (>1.5X) of C-section (CS) is possible in WWE. CS poses a high morbidity, and it is unknown how seizures influence perinatal obstetrical management. This study aims to determine the rate of CS in WWE on AED as compared to women without epilepsy not taking an AED [WWoE]. Our hypothesis is that WWE have a higher rate of CS than WWoE. This study explores if specific AED(s) in WWE have a higher association with CS, and if there is a specific etiology for CS, including seizure. Methods: The NAAPR is a voluntary call-in registry of women who are taking AEDs. Participants are asked a series of questions twice during pregnancy and once postpartum. Using self-reported answers, we determined how many WWE had a CS. An internal control group of WWoE on no AEDs was used in comparison. Results: There were 6,253 WWE in the analysis as compared to 469 WWoE. WWE were slightly younger (29.5 ±5.4 v. 31.5 ±4.1 years) (p<0.001) and were less likely to have had a previous delivery (parity 0.8 ± 0.9 v. 1.0 ± 0.9, p<0.001), but were likely to have had an equal number of pregnancies (gravidas 2.2 ± 1.3 v. 2.3 ± 1.3, p=0.1). WWE were more likely to report smoking during the first trimester (14.1% v. 6.8%, p<0.05). There was a lower proportion of non-whites among WWoE (p<0.001), and the most common AEDs were lamotrigine (26.1%) followed by carbamazepine (22.9%). A total of 34.5% of WWE had a CS as compared to 29.8% of WWoE , p=0.05. The increased odds of receiving a CS for WWE loses significance with adjustment for age, parity and pre-existing hypertension (OR: 1.03 95% CI: 0.54, 2.0, p=0.9). Independent of disease and drug status, age (OR: 1.1, 95%CI: 1.0 - 1.1), parity OR: 0.8 95%CI = 0.7- 0.9) and pre-existing hypertension (OR: 2.2, 95%CI = 1.5 - 3.3) are variables significantly associated with reporting a CS delivery in both WWE and WWoE. Conclusions: There is borderline difference in the rate of CS between WWE and WWoE when adjusted for the confounders of age, parity, and pre-existing hypertension. This study is limited by retrospective, patient-reported outcomes, and information on confounders. Future Directions: These findings will be examined by etiology of CS and by drug. Future studies will include other perinatal outcomes. Future NAAPR participants will be asked detailed questions on obstetrical and neonatal outcomes to enhance these findings.