To evaluate if seizure-freedom in pregnancy predicts seizure-freedom in the postpartum period in people with epilepsy of childbearing potential (PWECP), and if it varies by seizure type.
When planning pregnancy, PWECP can be reassured that seizure-freedom in the preconception 9 months is highly predictive of seizure-freedom during pregnancy. However, no studies have prospectively investigated if seizure control during pregnancy similarly predicts the postpartum course. Postpartum is a particularly vulnerable period due to sleep disruption, stress, changing hormones and ASM concentrations, and often complex dosing regimen changes. Newborn safety also is of concern. There is limited data to counsel patients about the risk of postpartum seizures.
Pregnant PWECP, ages 14-45yo, enrolled <20 weeks gestational age in the longitudinal, prospective cohort study, Maternal Outcomes and Neurodevelopmental Effects of Anti-epileptic Drugs (MONEAD), were included in this analysis. Participants were followed until 9 months postpartum, with electronic daily seizure and medication diaries and study visits approximately every three months to verify diary entries and for other study protocol procedures. Using logistic regression, we evaluated the association between seizure-freedom during pregnancy and seizure-freedom postpartum, with further inquiry into seizure types.
331 pregnant PWECP met inclusion criteria for this analysis. Percentages seizure-free were 60% during pregnancy and 61% postpartum. PWECP who were seizure-free during pregnancy were more likely to be seizure-free postpartum (OR 6.53, p<0.0001). The predictive value of seizure-freedom during pregnancy for postpartum seizure freedom was 78% (95% Confidence Interval 72-84%). The strength of the association was the same for focal impaired awareness, convulsive, and generalized seizures.
Our data demonstrated that seizure-freedom during pregnancy, regardless of seizure type, is a robust predictor of seizure-freedom during the postpartum period. These data can be used to counsel patients about seizure risk in the postpartum period.