Abstracts

Rationale: The Women with Epilepsy: Pregnancy Outcomes and Deliveries (WEPOD) study is a multi-center prospective, observational study evaluating fecundity in women with epilepsy (WWE) compared to healthy controls (HC) as they progress from attempting conception through pregnancy and delivery. Sample size was chosen to detect differences in pregnancy rates. Previous studies have suggested that WWE have more anovulatory cycles compared to HC. This secondary analysis was performed to explore if ovulation rates differed in WWE and HC.Methods: Women with epilepsy and healthy controls, ages 18-41 years, seeking pregnancy were enrolled within 6 months of discontinuing contraception. The customized WEPOD electronic diary application captured medication use, seizures, sexual activity, and menstrual bleeding. We defined cycle length as the number of days from the onset of one menstrual bleed until the first day of the next bleeding episode. We collected serum to determine the luteal progesterone level on cycle Day 21 + 1 day for up to two menstrual cycles. Collections that occurred >14 days prior to the next menstrual onset were not included in the analysis. A luteal progesterone level > 3 ng/ml or a confirmed pregnancy in the measured cycle indicated the occurrence of ovulation. Multiple logistic regression was used to determine the association between baseline factors and ovulation status. Generalized estimating equations were used for estimation of the regression coefficients and their standard errors.Results: Ninety WWE and 109 HC were enrolled in the study. Demographics are listed in Table 1. There were no differences in baseline characteristics across groups except for race, for which there was a greater proportion of white subjects in the WWE group. In WWE, 113 (89%) out of 127 cycles were considered ovulatory. For HC, 127 (82%) out of 155 cycles were considered ovulatory. A total of 276 cycles were included in the regression analysis, and BMI was the only baseline factor associated with ovulatory status (p=0.013), with a BMI > 25 associating with anovulation. There was no association between ovulatory status and the presence of epilepsy (p=0.18), age (p=0.12) or race (p=0.81).Conclusions: This preliminary analysis found that ovulation rates were similar in WWE and HC. BMI was found to be a statistically significant predictor of ovulation, consistent with studies in the general population. These findings should be reassuring to clinicians when counseling WWE who are planning pregnancy, in that ovulatory status is likely to be typical of the general population. Study supported by: The Epilepsy Foundation.