Women With Multiple Sclerosis or Epilepsy Have Safe Pregnancies

Allison Gandey

November 19, 2009

November 19, 2009 — New national data suggest that the 2 most common neurologic disorders affecting women of childbearing age are not stopping families. "We think that the most important take-home message for clinicians and women with multiple sclerosis or epilepsy is that pregnancy outcomes are generally reassuring and not associated with terribly high risks of pregnancy complications," Eliza Chakravarty, MD, from Stanford University in California, told Medscape Neurology.

The research team used a nationally representative database of hospitals in the United States. Of an estimated 18.8 million deliveries, more than 10,000 occurred in women with multiple sclerosis and more than 4700 in women with epilepsy.

"Intrauterine growth restriction was the only outcome we looked at that was seen in higher frequency in women with multiple sclerosis or epilepsy," said Dr. Chakravarty, the senior investigator on the study. The work was published online November 18 in Neurology.

In an accompanying editorial, Gary Franklin, MD, from the University of Washington in Seattle, and Helen Tremlett, PhD, from the University of British Columbia in Vancouver, call the work "a welcome addition to several recent population-based studies that shine a little more light on the issue."

Investigators compared national pregnancy outcomes in women with multiple sclerosis and epilepsy to the general obstetric population and to women with known high-risk pregnancies due to diabetes mellitus.

Multivariable Odds Ratio (95% Confidence Intervals) for Risk for Adverse Pregnancy Outcomes

Group Hypertensive Disorders Premature Rupture Intrauterine Growth Restriction Cesarean Delivery
Multiple sclerosis 1.1 (0.9 – 1.4) 0.9 (0.7 – 1.3) 1.7 (1.2 – 2.4) 1.3 (1.1 – 1.4)
Epilepsy 1.2 (0.9 – 1.7) 0.8 (0.5 – 1.5) 1.9 (1.2 – 3.3) 1.5 (1.3 – 1.9)
Diabetes mellitus 4.5 (4.4 – 4.7) 1.2 (1.1 – 1.3) 1.4 (1.3 – 1.5) 2.9 (2.8 – 3.0)

"The strength of the study is that we were able to look at a large number of pregnancies over a short time point," said Dr. Chakravarty. "This gives us a bird's-eye overview of pregnancy outcomes in women with these relatively rare chronic diseases."

However, she added, "The trade-off for large numbers of subjects is the relative lack of detail about them. We don't have data on very important factors associated with pregnancy, such as medication use — a huge issue — prenatal care, severity of disease, smoking, alcohol, obesity, and past reproductive history."

The editorialists say that because of these limitations, the data on epilepsy are of limited use. They argue substantial misclassification was likely, resulting in severe underreporting of deliveries and an inability to consider antiepileptic drugs, which are already linked to adverse birth outcomes.

"It's hard to get good estimates of how many women with epilepsy have babies each year," Dr. Chakravarty told Medscape Neurology. "We suspect that women who have a remote history of epilepsy and who are not taking epilepsy medications during pregnancy or have not had any seizures during pregnancy were probably much less likely to have that diagnosis placed on the discharge summary, so we may have captured the more severe or active end of the epilepsy spectrum."

Weighing the Risks

Dr. Chakravarty says it will be important to compare these results to other studies. She said her team was surprised by the lack of data in the literature about pregnancy outcomes in women with multiple sclerosis. "There are excellent studies looking at what a pregnancy does to the course of disease but very little about what having multiple sclerosis does to a pregnancy."

The editorialists agree that investigators are still a long way from being able to produce evidence-based practice guidelines in multiple sclerosis, but they write, "The Stanford group and others, in conducting population-based studies using existing computerized databases, are beginning to supply the critical information needed for this essential task."

"The primary indication is that women should not necessarily be discouraged from becoming pregnant just because they have a diagnosis of multiple sclerosis or epilepsy," Dr. Chakravarty added. "As always, each patient should discuss her individual situation with her doctor so that all of the potential risk factors can be examined. In cases of chronic diseases, the medications need to be considered, as well as the disease activity before conception."

Coauthor Lorene Nelson, PhD, reports having received an honorarium from BioSymposia Inc and serves on a data safety monitoring board for NeuroPace Inc.

Neurology. Published online November 18, 2009.


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