Association of Epilepsy and Severe Maternal Morbidity.

Autor:	Panelli DM; Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, the Division of Neonatal and Developmental Medicine, Department of Pediatrics, and the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts., Leonard SA, Kan P, Meador KJ, McElrath TF, Darmawan KF, Carmichael SL, Lyell DJ, El-Sayed YY, Druzin ML, Herrero TC
Jazyk:	angličtina
Zdroj:	Obstetrics and gynecology [Obstet Gynecol] 2021 Nov 01; Vol. 138 (5), pp. 747-754.
DOI:	10.1097/AOG.0000000000004562
Abstrakt:	Objective: To evaluate severe maternal morbidity (SMM) among patients with epilepsy and patients without epilepsy. Methods: We retrospectively examined SMM using linked birth certificate and maternal hospital discharge records in California between 2007 and 2012. Epilepsy present at delivery admission was the exposure and was subtyped into generalized, focal and other less specified, or unspecified. The outcomes were SMM and nontransfusion SMM from delivery up to 42 days' postpartum, identified using Centers for Disease Control and Prevention indicators. Multivariable logistic regression models were used to adjust for confounders, which were selected a priori. We also estimated the association between epilepsy and SMM independent of comorbidities by using a validated obstetric comorbidity score. Severe maternal morbidity indicators were then compared using the same multivariable logistic regression models. Results: Of 2,668,442 births, 8,145 (0.3%) were to patients with epilepsy; 637 (7.8%) had generalized, 6,250 (76.7%) had focal or other less specified, and 1,258 (15.4%) had unspecified subtypes. Compared with patients without epilepsy, patients with epilepsy had greater odds of SMM (4.3% vs 1.4%, adjusted odds ratio [aOR] 2.91, 95% CI 2.61-3.24) and nontransfusion SMM (2.9% vs 0.7%, aOR 4.16, 95% CI 3.65-4.75). Epilepsy remained significantly associated with increased SMM and nontransfusion SMM after additional adjustment for the obstetric comorbidity score, though the effects were attenuated. When grouped by organ system, all SMM indicators were significantly more common among patients with epilepsy-most notably those related to hemorrhage and transfusion. Conclusion: Severe maternal morbidity was significantly increased in patients with epilepsy, and SMM indicators across all organ systems contributed to this. Competing Interests: Financial Disclosure Kimford J. Meador disclosed that money was paid to his institution by Eisai Inc. and Sunovion Pharmaceuticals. The Epilepsy Study Consortium pays Kimford J. Meador's university for his research consultant time related to Eisai, GW Pharmaceuticals, NeuroPace, Novartis, Supernus, Upsher-Smith Laboratories, UCB Pharma, and Vivus Pharmaceuticals. Thomas F. McElrath disclosed receiving compensation from Hoffman—LaRoche, NxPreatal, Comanche Biopharma, and Momenta Pharmaceuticals, Inc. for serving on their scientific advisory boards in work that is unrelated to the present analysis. Deirdre J. Lyell disclosed receiving funds from Bloomlife (stock options for consulting, unrelated to this work). She also received payment from SMFM and UCSF for lectures. The other authors did not report any potential conflicts of interest. (Copyright © 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu