Pauline Anderson

April 18, 2016

VANCOUVER — Having epilepsy doesn't appear to affect chances of getting pregnant. A new study shows that women with epilepsy who tried to have a baby had about the same success rate as healthy controls also eager to get pregnant.

The study is "myth busting," said study co-principal Investigator, Cynthia Harden, MD, system director of epilepsy services, Mirken Department of Neurology, Mount Sinai Beth Israel, New York, New York.

Dr Harden presented her findings at the American Academy of Neurology (AAN) 2016 Annual Meeting.

Dr Cynthia Harden

Previous research showed that women with epilepsy have up to one third lower birth rates compared with healthy controls, which might suggest more infertility. However, Dr Harden stressed that just because women decide not to have a child does not necessarily mean they're not capable of getting pregnant. "They just choose not to have children."

She added that in one study, the difference in offspring between women with and without epilepsy is accounted for by those with severe comorbidities, "who are very disabled and not going to get pregnant anyway."

The Women with Epilepsy Pregnancy Outcomes and Deliveries (WEPOD) is a multicenter, prospective observational study that evaluated women keen to get pregnant. The study enrolled 89 patients with epilepsy and 109 controls, aged 18 to 40 years, within 6 months of discontinuing contraception.

Researchers followed the women for 1 year, from attempting conception through their pregnancy and delivery.

Customized App

Participants used an app especially developed for the study. Women with epilepsy used this tool to track medication use, seizures, frequency of sexual activity, and menstrual bleeding; mood was optional. Healthy controls used the app to note menses and sexual activity.

The two groups were similar in many demographic characteristics, including mean age (31.9 years in the epilepsy group and 31.1 years in the healthy controls), body mass index (BMI; 25.3 and 25.2 kg/m2), percentage with a prior pregnancy (51.7% and 57.8%), education, and parity.

However, the healthy controls had fewer whites and a greater proportions of minorities, including African American and Asians.

The researchers found that the cumulative pregnancy rate was 70.0% in the epilepsy group and 67.1% in the healthy controls.

The average time to achieve a pregnancy was 6.03 months in the epilepsy group (95% confidence interval [CI], 3.8 - 10.1 months) and 9.05 months in the healthy control group (95% CI, 6.5 - 11.2 months) (P = .30).

"There are wide confidence intervals around both these estimates and so the P value is not significant," noted Dr Harden.

She also pointed out that on the cumulative hazard graph of time to pregnancy, the two groups "are actually tracking very close together."

(The 18 early discontinuations from the epilepsy group [20%] and the 15 from the healthy control group [14%] were included in this hazard graph.)

There was no significant difference in live births: 81.8% for the epilepsy group and 80% for healthy controls.

More miscarriages occurred among the healthy controls (20% vs 12.7%), but the rates were not statistically different, said Dr Harden. "Both are within the expected rates for the general population."

Further analysis showed no effect of BMI on achieving pregnancy but indicated that age was a factor and so was parity, "as was expected," Dr Harden reported.

The researchers concluded that "we can likely advise women with epilepsy who are trying to get pregnant that they have as good a chance to achieve pregnancy than if they didn't have epilepsy," said Dr Harden.

She and her colleagues are planning to analyze other data they have captured that might be important for counseling women with epilepsy. This includes information on sexual activity (how frequently and when participants have intercourse), and on ovulation.

"The group with more anovulatory cycles might have decreased pregnancy rates," commented Dr Harden. "Anovulation has been reported to occur more frequently in women with epilepsy than in the general population of women." However, Dr Harden said she doesn't think these factors will have a significant effect on the findings.

One factor that can make a difference is choice of antiepileptic drug. Almost all the women with epilepsy in this study were receiving monotherapy with lamotrigine (Lamictal, GlaxoSmithKline) or levetiracetam (Keppra, UCB Inc), which are considered to be the safest drugs in pregnancy.

Important Conclusions

Asked to comment, David J. Dickoff, MD, a general community neurologist in Yonkers, New York, said he found the study "enlightening" because it addresses questions many of his young female epileptic patients ask.

"Two of the questions that patients ask me frequently when they're planning a family are, 1) Will my epilepsy or the treatment of my epilepsy affect my ability to conceive? and 2) What risks does my epilepsy and the medications and treatments pose for the baby?"

Although the study is relatively small, "I think the conclusions are very, very important — including that women with epilepsy have the same rate of conceiving an infant as their nonepileptic peers," said Dr Dickoff. "So a 22-year-old girl with epilepsy in my practice can get pregnant as easily as her next-door neighbor without epilepsy."

Although the difference in miscarriage risk wasn't statistically significant, it means "you can tell epilepsy patients that, based on this small study, they don't seem to have a higher rate of miscarriage. These often represent, of course, fetal deformities, which are the main concern with the antiepileptic drugs."

Dr Dickoff also commented that the study appears to confirm that use of levetiracetam and lamotrigine "in this small population seems to be safe, and that's good news."

The authors have disclosed no relevant financial relationships.

American Academy of Neurology (AAN) 2016 Annual Meeting. Session I5 Data Blitz 15.001 S22.005. Presented April 17, 2016.


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