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Poster session I Clinical obstetrics, epidemiology, fetus, medical-surgical complications, neonatalogy, physiology/endocrinology, prematurity: Abstracts 87 - 236| Volume 208, ISSUE 1, SUPPLEMENT , S56, January 01, 2013

99: Obstetrical outcomes in women with epilepsy enrolled in the North American Antiepileptic Drug Registry (NAAPR)

      Objective

      Little is known about obstetrical and neonatal outcomes in women with epilepsy (WWE) taking antiepileptic drugs (AEDs). This study aims to determine the rate of C-section (CS) in WWE on AEDs compared to women without epilepsy not taking an AED (WWoE) and to determine if there is an indication for CS, including seizure.

      Study Design

      The NAAPR, which began in 1997, is a voluntary call-in registry of pregnant women taking AEDs. Participants are asked a series of questions twice during pregnancy and once postpartum. We determined how many WWE and WWoE reported having a CS and classified their responses into different indications. WWE were compared to WWoE.

      Results

      There were 6,253 WWE reporting AED use at the time of last menstrual period and 469 WWoE. WWE were slightly younger (29.5 ± 5.4 v. 31.5 ± 4.1 years) (p<0.001) and were less likely to have had a previous delivery (parity 0.8 ± 0.9 v. 1.0 ± 0.9, p<0.001), but were likely to have had an equal number of pregnancies (gravidas 2.2 ± 1.3 v. 2.3 ± 1.3, p=0.1). WWE were more likely to report smoking during the first trimester (14.1% v. 6.8%, p<0.05). There was a higher proportion of whites among WWoE (p<0.001), and the most common AEDs were lamotrigine (26.1%) followed by carbamazepine (22.9%). A total of 34.5% of WWE had a CS as compared to 29.8% of WWoE (p=0.05), but when adjusted for age, parity and pre-existing hypertension, these findings are no longer significant (OR: 1.03 95% CI: 0.54, 2.0, p=0.9). Of WWE, 10.5% reported seizure as a reason for their CS.

      Conclusion

      There is borderline difference in the rate of CS between WWE and WWoE when adjusted for the confounders of age, parity, and pre-existing hypertension. Seizure was reported as an indication for CS in a significant number of WWE and suggests that WWE may benefit from specialized multi-disciplinary care at larger hospitals. Future studies will examine other obstetrical and neonatal outcomes including CS and SGA by AED.