Abstracts

Rationale: Outcomes in women with epilepsy and pregnancy are based upon national and international registries which have a higher predominance of Caucasian or Asian heritage ethnicities. There is a dearth of information on pregnancy and fetal outcomes in African American (AA) women with epilepsy (WWE). We reviewed the pregnancy demographics, complications and outcomes in a highly predominant AA population of WWE at our center. Methods: A retrospective chart review of WWE who were pregnant seen in the Comprehensive Epilepsy Center in Detroit, Michigan, was performed from August 2013 through March 2019. We collected patient demographics including age, ethnicity, and duration of seizures at time of pregnancy, planned vs unplanned pregnancy, use of preconception folic acid, seizure frequencies, pregnancy complications, and fetal outcomes. Duration of seizures was calculated from the difference between age at pregnancy and onset of epilepsy. We analyzed the data in the total population and then in our AA population compared to other ethnicities as well as planned vs. unplanned pregnancy data. Results: Our cohort had a total of 98 WWE and 104 pregnancies. The average age of the mother at time of pregnancy was 22 years (15-43 years). AA comprised 77.5% of the cohort and 22% included a majority of Caucasians and other ethnicity groups. The average duration of epilepsy at time of pregnancy was 10.75 years (0-32 years). Twenty-one (20%) pregnancies were planned and 80% were unplanned. In the year prior to pregnancy, 61.5% of the total cohort had at least one seizure. Of these patients, 53% of them had at least one seizure during pregnancy, labor and delivery or in the 6 weeks post-partum. In the entire population, 47 pregnancies had at least one seizure during pregnancy (not including labor and delivery or post-partum) and 98% of these patients had a seizure in the year prior to pregnancy.In African Americans WWE, the average age of women at time of pregnancy was 26.2 years (15-43 year). The average duration of epilepsy was 11 years. Eighty-three percent were unplanned pregnancies in AA versus 63% in other ethnicity groups (p =0.0155, z-score -2.158). Sixty-three percent of AA WWE did not take preconception folic acid. Of pregnancies in AA women, 62% had at least one seizure one year prior to pregnancy. Of these, 76% had at least one seizure during pregnancy, labor and delivery or in the 6 weeks post-partum, compared to 92% in Caucasians and others. A total of 40 pregnancies in AA WWE had seizures during pregnancy and 36 also had seizures in the year prior to pregnancy. In the AA women who had seizures during pregnancy, fetal complications included 2 small for gestational age infants, 4 premature deliveries and 1 intrauterine growth retardation (IUGR). We had a total of 20% planned and 80% unplanned pregnancies. Pre-conception folic acid was taken by 38% in the planned group and 24% in the unplanned group. Seizure frequency during pregnancy was 43% and 48% in planned and unplanned pregnancies, respectively. Fetal outcomes in the unplanned group were more frequent and severe with 2 intrauterine fetal deaths and 3 premature deliveries. In addition there were three cases of sudden infant death syndrome within the first year in unplanned pregnancy births. Conclusions: This study highlights the importance of close monitoring of WWE during and after pregnancy. African American women tend to have more complicated pregnancies in urban geographical locations. WWE face further complications related to medication use and seizure burden. Certain variables such as a larger percentage of unplanned pregnancy which was statistically significant in our cohort may play an important factor in more complicated outcomes. Further larger prospective databases dedicated to these population groups are needed to guide planning and monitoring to achieve favorable maternal and fetal outcomes. Funding: No funding