Abstracts

Rationale: Nearly 500,000 women of child-bearing age are affected by epilepsy and its comorbidities in the United States (1). Although the majority of women with epilepsy deliver a healthy baby, approximately 10% of women and/or the fetus/neonate experience complications from epilepsy and antiepileptic drugs (AEDs), such as gestational hypertension, preterm labor and delivery, seizures, status epilepticus, and mortality (2-13). We describe preliminary demographic and clinical characteristics of pregnant women (PW) with epilepsy compared with PW with lower extremity fracture (LEF) in South Carolina, 2005-2011. Methods: All hospital and emergency department (ED) encounters for PW with epilepsy and LEF aged 15 - 44 years were identified. Epilepsy was determined by a diagnosis of ICD-9-CM: 345.x and/or 780.39; a single LEF of the tibia, fibula, or ankle by ICD-9-CM: 823.x-824.x; and pregnancy by ICD-9-CM: V22 or V23. Women with LEF served as a comparison group as their general health status relatively approximates the health status of the general population. Demographic characteristics and the prevalence of comorbidities that may affect the outcome of pregnancy were compared among the groups. Results: 2,052 PW with a diagnosis of epilepsy (n=1,274, 62.1%) or LEF (n=778, 37.9%) were identified. Compared to PW with LEF, a significantly greater proportion of PW with epilepsy were diagnosed with any somatic, neurodevelopmental, or mental health comorbidity. Specifically, the odds of diabetes (Odds ratio [OR]=1.47, 95% confidence [CI]: 1.07, 2.02), drug abuse (OR=1.60, 95% CI: 1.23, 2.08), depression (OR=1.43, CI: 1.14, 1.80) asthma/pulmonary disorders (OR=1.33, 95% CI: 1.09, 1.64), and nutritional deficiency (OR=2.84, 95% CI: 1.39, 5.78) were significantly elevated in PW with epilepsy compared to PW with LEF. Analyses were adjusted for demographics (age, race/ethnicity, payer insurance status) and primary variables of interest which included: diabetes, hypertension, heart disease, psychosis or schizophrenia, personality disorder, depression, anxiety, psychoses, tobacco use disorder, alcohol abuse, drug abuse, asthma/pulmonary disorders, and nutritional deficiency. The absolute risk increase for PW with epilepsy compared with PW with LEF was 47% for diabetes, 60% for drug abuse, 43% for depression, 33% for asthma/pulmonary disorders, and 184% for nutritional deficiency. Conclusions: PW with epilepsy have an elevated burden of comorbidities that could negatively affect the course of the pregnancy and their offspring. Frequent and rigorous evaluation of PW with epilepsy is warranted to manage comorbidities and prevent deleterious outcomes.