Obstetrical Outcomes in Women with Epilepsy on Lamotrigine or Levetiracetam Monotherapy at a Tertiary Care Hospital
Abstract number :
2.124
Submission category :
4. Clinical Epilepsy / 4E. Women's Issues
Year :
2021
Submission ID :
1826696
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:55 AM
Authors :
Regan Lemley, MD, MS - Brigham and Women's Hospital; Thomas McElrath, MD, PhD - Associate Professor, Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital; Mallika Purandare - Brigham and Women's Hospital; Elizabeth Shashkova - Brigham and Women's Hospital; Page Pennell, MD - Professor of Neurology, Brigham and Women's Hospital; P. Emanuela Voinescu, MD, PhD - Associate Professor, Brigham and Women's Hospital
Rationale: Women with epilepsy (WWE) have been shown to have an increased risk of pregnancy complications, including an increased risk of cesarean section (CS) and premature birth. This study aims to describe obstetrical outcomes in WWE managed at a tertiary care center with specialized epilepsy and obstetrical providers, on either of the two most commonly prescribed antiseizure medications in pregnancy, lamotrigine and levetiracetam.
Methods: A longitudinal prospective database was utilized to select WWE on lamotrigine or levetiracetam monotherapy who were followed in the Epilepsy and Obstetric clinics and delivered at Brigham and Women’s Hospital between January 2018 and December 2020. Additional chart review was performed to retrospectively collect information on obstetrical outcomes and complications. Exclusion criteria included non-epileptic seizures, medication non-adherence, or abortion.
Results: 57 women and 58 pregnancies were included in the study. 5 pregnancies (8.8%) resulted in premature births, defined as delivery prior to 37 weeks of gestation. Each premature birth occurred in the setting of a medical complication such as cord prolapse or pre-eclampsia with severe features, and CS was the method of delivery in each premature birth. 21 pregnancies (36.8%) resulted in cesarean section, only 5 of which were elective. Within the 5 elective cesarean sections, 3 patients preferred this method of delivery due to having prior cesarean sections, one patient had physical abnormalities deemed contradictory to vaginal delivery, and one fetus was in breech presentation prompting scheduled CS. The majority (16 of 21) of cesarean sections occurred due to maternal and fetal complications such as labor arrest (5 in first stage of labor, 2 in the second stage), non-reassuring fetal heart testing (4), fetal heart decelerations during first stage labor (2), uterine artery doppler abnormalities (1), cord prolapse (1), and pre-eclampsia (1). Though there was a similar number of women on lamotrigine (27) and levetiracetam (30), a greater percentage of women on levetiracetam (43.3%) delivered by CS when compared to women on lamotrigine (29.6%). Of all deliveries, 38 (64%), began with elective induction of labor (eIOL), and 11 (28.9%) inductions ended in CS rather than vaginal delivery.
Conclusions: WWE on lamotrigine and levetiracetam whose pregnancies are managed by epileptologists and obstetricians at a tertiary care hospital have similar rates of premature births when compared to the average prematurity rate in the United States, and the rate of cesarean section is higher (36.8%), but comparable to the national average (31.9%). WWE with epilepsy have higher than average rates of eIOL. Levetiracetam may be associated with a higher risk of CS when compared to lamotrigine. Further studies are required to validate these findings.
Funding: Please list any funding that was received in support of this abstract.: none.
Clinical Epilepsy