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Friday, November 16, 2018

Unplanned Pregnancy May Double Spontaneous Fetal Loss Risk in Women with Epilepsy


Unplanned pregnancy in women with epilepsy was associated with double the risk of spontaneous fetal loss compared to women with epilepsy who planned their pregnancy, according to a retrospective study published online on October 15 in JAMA Neurology.

The rate of spontaneous fetal loss occurred in 35 percent of unplanned versus 16 percent of planned pregnancies among women with epilepsy.

"This analysis adds the finding that unplanned pregnancy may increase the risk of [spontaneous fetal loss] in women with epilepsy and identifies pregnancy planning, maternal age, and interpregnancy interval as significant modifiable variables," the researchers, led by Andrew G. Herzog, MD, MSc, of Beth Israel Medical Center in Boston, wrote.

In an interview with Neurology Today, Kimford J. Meador, MD, FAAN, professor of neurology and neurosciences at Stanford University, and clinical director of the Stanford Comprehensive Epilepsy Center, who was not involved with the study, said the key message from this study and others related to pregnancy in women with epilepsy remains the same: "It's very important for us as clinicians to talk with women who have epilepsy about planning for pregnancy and pregnancy prevention."

Current epilepsy practice guidelines suggest that women with epilepsy should plan their pregnancies to occur when they have achieved "optimal seizure control on the minimum effective dosage of [antiepileptic drugs] and take recommended dosages of folic acid supplement before conception to achieve optimal maternal and fetal outcomes, " the study authors noted.

However, despite these guidelines, 65 percent of pregnancies in women with epilepsy are unplanned.

To evaluate whether planned pregnancy is associated with spontaneous fetal loss in women with epilepsy, the researchers conducted a web-based retrospective survey from 2010 to 2014 completed by 1,144 women in the Epilepsy Birth Control Registry. 

On average, survey respondents were aged 28.5 years; 40 percent had household incomes of $25,000 or less, and minority women only represented 8.7 percent of participants.

Data included pregnancy history, such as the number of pregnancies, number of planned or unplanned pregnancies, AEDs used during pregnancies, and pregnancy outcomes such as live birth, induced abortion, and spontaneous fetal loss, or participants could choose to decline to answer. The researchers included loss of pregnancy before delivery, except for induced abortion, in the spontaneous fetal loss category. The term "unaborted" was used to refer to pregnancies not medically terminated.

AED data included categorizing patients into no therapy, monotherapy, and polytherapy groups. AED use was further subdivided into no AED, enzyme-inducing AED, non–enzyme-inducing AED, enzyme-inhibiting AED, glucuronidated AED, and mixed category groups.

Of the 794 pregnancies that occurred, 530 were unplanned (66.8%) and 264 were planned (33.2%), with 473 live births (59.6%), 141 induced abortions (17.8%), and 180 spontaneous fetal loss (22.7%).

The team concluded that the increased risk of spontaneous fetal loss in unplanned pregnancies in women with epilepsy, and due to the potential that a woman with epilepsy with a history of spontaneous fetal loss may increase the risk of her live-born offspring developing epilepsy, more research is needed.

"[T]he finding warrants prospective investigation with medical record verification of pregnancy outcomes" they wrote.

Study limitations included the reliance on self-reported information not verified by medical records; underreporting due to stigmatized health information, which may have led women to report fewer induced abortions in favor of spontaneous fetal loss despite the survey being anonymous and having the option to decline to answer the question about pregnancy outcome; and the underrepresentation of minority women.

The Epilepsy Foundation and Lundbeck funded the study. Researchers reported relationships with the Epilepsy Foundation and Lundbeck.


Herzog AG, Mandle HB, and MacEachern DB. Association of unintended pregnancy with spontaneous fetal loss in women with epilepsy: Findings of the Epilepsy Birth Control Registry. JAMA Neurol 2018; Epub 2018 Oct 15.