The Obstetrical Care and Delivery Experience of Women with Epilepsy in the MODEAD Study. American journal of perinatology McElrath, T. F., Druzin, M. L., Van Marter, L. J., May, R., Brown, C., Stek, A. M., Grobman, W., Dolan, M., Chang, P., Flood-Schaffer, K., Parker, L., Meador, K., Pennell, P. 2022


OBJECTIVE: We examined mode of delivery among pregnant women with epilepsy (PWWE) vs. pregnant controls (PC). We hypothesize that PWWE are more likely to deliver by cesarean.STUDY DESIGN: The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is an observational, prospective, multi-center investigation of pregnancy outcomes funded by the NIH. MONEAD enrolled subjects December 2012 through January 2016. PWWE were matched to PC in a case:control ratio of 3:1. This analysis had 80% power to detect a 36% increase in cesarean frequency assuming a baseline rate of 30% among PC at an alpha=0.05.RESULTS: This report analyzed 331 PWWE (76%) and 102 PC (24%) who gave birth while enrolled in the study. PWWE and PC had similar rates of cesarean delivery (34.7% vs. 28.6%; P=0.27). Of women with cesarean, rates of cesarean without labor were similar between groups for those delivering in recruitment hospitals (48.2% vs. 50.0%), but in non-recruitment hospitals, cesarean rates without labor were over two-fold higher among PWWE than those of PC (68.8% vs. 30.8%; p-value=0.023). Receipt of a cesarean after labor did not differ for PWWE compared to PC, or by type of antiepileptic drug among the PWWE.CONCLUSION: These findings suggest that the obstetrical experiences of PWWE and PC are similar. An interesting deviation from this observation was the mode of delivery with higher unlabored cesarean rates occurring among PWWE in non-recruitment hospitals. As the study recruitment hospitals were tertiary academic centers and non-recruitment hospitals tended to be community-based institutions, differences in perinatal expertise might contribute to this difference.

View details for DOI 10.1055/a-1788-4791

View details for PubMedID 35253116