Pregnancy Outcomes and Seizure Control in Underserved Patients with Epilepsy
Anna Serafini1, Alexa King2, Parisa Hassanzadeh1, Elizabeth Cunningham3, Assia Mezziane-Tani4, Alexandra Moise4, Elizabeth Gerard5
1University of Illinois At Chicago, 2Northwestern University, McGaw Medical Center, 3Northwestern university, 4Jessie Brown VA, 5Northwestern University
Objective:
To assess whether pregnant persons with epilepsy in underserved population (UPPWE) face different pregnancy outcomes when compared to a non-underserved population (NUPPWE) within the same urban setting.
Background:
Most prospective studies of pregnancy outcomes have enrolled predominantly white participants. Pregnancy outcomes in racially diverse and lower socioeconomic status patients have not been well studied.
Design/Methods:
We conducted a retrospective comparison of pregnancy outcomes at two University hospitals in the same urban setting, each serving distinct patient populations. One of the two hospitals is a state hospital predominantly serving UPPWE. All PPWE who delivered between 1/1/2017 and 11/24/2019 were included. Information regarding demographics, epilepsy history, ASMs, seizure control during pregnancy, pregnancy data, and pregnancy outcomes were collected. Chi-square and Fisher’s exact tests were used to estimate associations between categorical variables as appropriate.
Results:
Significant demographic disparities were seen between the two patient populations: UPPWE were predominantly Black (45.7%), while NUPPWE were mostly White (87.9%) (p<0.001). Median income was less than $29k for 54.3% of UPPWE , compared to 63.7% with incomes above $80k in NUPPWE (p<0.001). Pregnancies were less likely to be planned (35.3% vs. 83.3%; p=0.001). Seizures with impaired awareness were more prevalent in UPPWE (51.4% vs. 12.1%; p<0.001), as were convulsive seizures (34.3% vs 9.1%; p=0.012). Two cases of focal status epilepticus were reported in UPPWE. When ASM levels were available, they were more likely to be undetectable in UPPWE (62.1% vs. 19.4%; p=0.001). While not statistically significant, prematurity (<37 weeks) was more common in UPPWE (20.6% vs. 3%; p=0.054).
Conclusions:
It is essential to consistently consider UPPWE when analyzing the frequency of seizures and pregnancy outcomes. Many population studies are conducted at academic institutions that may not represent the entire population. Our data demonstrates that UPPWE are at an elevated risk of unplanned pregnancy and seizures that impair awareness during pregnancy.