Rationale:
Severe maternal morbidity has risen in recent years for unknown reasons. Prior work by MacDonald et al. demonstrated women with epilepsy (WWE) are at significant risk for adverse obstetric outcomes during delivery (Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States. JAMA Neurol. 72(9):981-988, 2015). Literature on short-term postpartum outcomes in WWE remains sparse. We analyzed patient-hospital characteristics and short-term maternal complications from the National Readmission Database (NRD) comparing WWE to women without common neurological comorbidities. Understanding current peri- and postpartum healthcare delivery for WWE is paramount to improving mother-baby outcomes.
Method:
A retrospective cohort analysis of short-term postpartum non-elective rehospitalizations was performed in the 2015-2017 NRD using International Classification of Diseases, Tenth Revision codes. The study population included all women ages 12-55 discharged after a viable delivery. WWE were compared to women without neurological comorbidities (to include epilepsy, migraine, pre-existing stroke, myasthenia gravis, and multiple sclerosis), herein referred to as controls. Wald chi-squared test was used to compare baseline demographic, hospital and clinical characteristics and postpartum complications between cohorts. Multivariable logistic regression models examined the likelihood of 30-day non-elective readmission between cohorts (alpha = 0.05).
Results:
A total of 38,518 WWE and 8,136,335 controls had a qualifying index admission for delivery. Baseline differences were most pronounced in Medicare/Medicaid insurance use (WWE: 58.2%, controls: 43%), alcohol/substance abuse (WWE: 8.3%, controls: 2.5%), psychotic disorders (WWE: 1.2%, controls 0.1%), mood disorder (WWE:15.5%, controls: 3.7%), eclampsia (WWE: 1.7%, controls 0.1%), or presence of any Center for Disease Control (CDC) severe maternal morbidity indicator (WWE: 3.2%, 0.6% controls). The 30-day non-elective readmission rate was 2.4% in WWE, 1.1% in controls. Controlling for baseline demographic, hospital and clinical differences between cohorts, the odds of post-partum non-elective readmission were higher in WWE (AOR 1.86, 95% CI 1.66-2.08, p-value < 0.0001).
Conclusion:
Our analysis demonstrates that maternal postpartum complications requiring 30-day readmission is significantly higher in WWE than women without epilepsy or other common neurological comorbidities. These preliminary findings highlight the need for further research in postpartum WWE to address crucial inconsistencies in multidisciplinary care. Further research is pivotal to contributing to evidence-based guidelines and improving maternal outcomes for WWE.
Funding:
:Dr. Decker receives funding from NIH T32-NS-061779. Dr. Willis receives funding from NIH 5R01NS099129.
FIGURES
Figure 1