Abstracts

Rationale: Low vitamin D levels have been associated with a higher risk of low birth weight and bone mass in infants. Clinical recommendations regarding Vitamin D replacement in pregnancy is insufficient. Women with Epilepsy (WWE) taking certain AEDs are particularly at risk for low bone densities and the effect of low Vitamin D on fetal outcomes are unknown in this particular population group. We present fetal and pregnancy outcomes in WWE correlating with Vitamin D levels before and during pregnancy. Methods: We performed a retrospective chart review of WWE who were pregnant seen in the Comprehensive Epilepsy Center in Detroit, Michigan, from August 2013 through March 2019. We collected patient demographics including age, ethnicity, duration of seizures at time of pregnancy, seizure frequencies, pregnancy complications, fetal outcomes and 25, OH-Vitamin D levels during preconception and each trimester. We analyzed the data in the patients with Vitamin D levels according to each step of pregnancy and the outcomes. We used Z-test for two proportions for statistical analysis. Results: Our cohort had a total of 98 WWE with 104 pregnancies. The average age of the mother at time of pregnancy was 22 years (15-43 years). Ethnicity was 77.5% African Americans, 22% Caucasians and others. The average duration of epilepsy at time of pregnancy was 10.8 years (range: 0-32 years). Overall, Vitamin D levels were checked at pre-conception, or the first or second trimester for the first time in 53 pregnancies. The first time vitamin D level was normal ( 25 ng/mL) in 10 pregnancies. Seven of these pregnancies with normal Vitamin D levels had seizures at least once during the pregnancy whereas in the 43 patients with lower than normal Vitamin D levels, 21 patients had seizures at least once in pregnancy (p = 0.8864, z score = 1.208). None of the women with normal Vitamin D levels had premature delivery or fetal complications. In women with initial low vitamin D level, two had seizures during labor and delivery, four had premature delivery (p = 0.1579, z score -1.003), two infants had major congenital malformation and one pregnancy resulted in intrauterine fetal death. Conclusions: Our study is the first to look at Vitamin D levels and seizure frequency and fetal outcomes in women with epilepsy. While our findings were not found to be statistically significant, there is some suggestion that low vitamin D may play a role in pregnancy and fetal health as well as premature delivery. Due to low sampling and reporting bias, we did not report the effects of Vitamin D supplementation that some of our patients did take and the effect it may have had on pregnancy and fetal outcomes. Further prospective studies on vitamin D replacement prior to pregnancy and the effect certain anti-epileptic medications have on pregnancy outcomes, fetal bone development would be warranted in guiding vitamin D replacement in pregnancy in WWE. Funding: No funding