Abstracts

Rationale: Since women with epilepsy (WWE) have higher rates of unintended pregnancies and unintended pregnancies may be associated with more adverse reproductive outcomes in the general population, this investigation assessed whether pregnancy outcomes (live births, induced abortions and spontaneous fetal loss) differed between unintended and intended pregnancies in WWE. Methods: The Epilepsy Birth Control Registry (EBCR) is a web-based survey and educational site that gathers demographic, epilepsy, antiepileptic drug (AED), contraceptive and reproductive data from WWE in the community. These retrospective data come from the first 550 WWE, 18-47 years of age, who completed the survey. We determined frequencies, rates and relative risks (RR) of live births, induced abortions and spontaneous fetal loss for unintended versus intended pregnancies. Spontaneous fetal loss is reported as a proportion of the non-aborted as well as the total number of pregnancies. Univariate ANOVA was carried out to determine whether pregnancy planning, pregnancy before or after the development of seizures, use of AEDs, maternal age and age of seizure onset were significant factors in determining live birth versus spontaneous fetal loss in non-aborted pregnancies. Results: 205 WWE reported 451 pregnancies of which 365 (80.9%) followed the development of seizures. Of the 348 for which we have planning and outcome data, 238 (68.4%) were unintended and 110 (31.6%) were intended. The unintended pregnancies resulted in higher rates of induced abortion [53/238 (22.3%) v 2/110 (1.8%); χ2 = 22.133, df = 1, p <.0001] and spontaneous fetal loss as a proportion of non-aborted pregnancies [55/185 (29.7%) v 18/108 (16.7%); χ2 = 6.220, df = 1, p = .0126] than did intended pregnancies (Table 1). The relative risk of spontaneous fetal loss as a proportion of non-aborted pregnancies was significantly greater for unintended than intended pregnancies [RR = 1.784 (95%CI: 1.108-2.872); p =.0173]. Pregnancy planning was the only significant factor related to pregnancy outcome, i.e. live birth versus spontaneous fetal loss, (p = .002). Of note, spontaneous fetal loss rates relative to non-aborted pregnancies did not differ significantly between pregnancies that occurred before (20/72 = 27.8%) versus after (73/293 = 24.9%) the development of seizures nor between pregnancies exposed to AEDs (44/136 = 32.4%) or no AEDs (7/25 = 28.0%). Conclusions: Interim analysis of the EBCR survey data raises the possibility that unintended pregnancies in WWE may be associated with significantly more spontaneous fetal loss, as well as induced abortions, than intended pregnancies. Pregnancy planning was the only statistically significant factor in pregnancy outcomes. The findings highlight the importance of developing guidelines for safe and effective contraception for pregnancy planning in WWE. Supported in part by the Epilepsy Foundation