'Alarming' Rate of Abuse in Pregnant Women With Epilepsy

Pauline Anderson

December 08, 2021

Women with epilepsy are more than twice as likely as those without the disorder to report physical, sexual, or emotional abuse during pregnancy, new research shows.

Study investigator Naveed Chaudhry, MD, a recent epilepsy fellow and assistant professor of neurology, University of Colorado School of Medicine, described the finding as "alarming" and called for more support for this patient population.

Investigators found that women with epilepsy are also more likely to report other stressors, including divorce, illness, lost pay, and partner discord, while expecting.

"As epilepsy physicians, it's important that we ask the right questions and dive a little bit deeper with these patients, even if it's uncomfortable and not something we're used to," said Chaudhry.

The findings were presented at the American Epilepsy Society (AES) 75th Annual Meeting 2021.

Cause for Concern

Women with epilepsy may be under stress for a variety of social and economic reasons. In some women, stress can trigger seizures, and during pregnancy, this can lead to complications such as pre-term labor and low birth weight.

For the study, researchers tapped into the Center for Disease Control and Prevention Pregnancy Risk Assessment and Monitoring System (PRAMS). This database includes information from surveys asking women across the US about their pregnancy and postpartum period.

Thirteen states collected data on stresses in women with and in those without epilepsy. Respondents were asked about 14 economic and other worries in the year prior to their baby's birth, including the pregnancy period.

The analysis included 64,951 women, 1140 of whom had epilepsy, who were included in surveys from 2012–2020. There were no significant demographic differences between those with and those without the disorder.

After adjusting for maternal age, race, ethnicity, marital status, education, and socioeconomic status, the study found that women with epilepsy experienced an average of 2.41 of the stressors compared to 1.72 for women without epilepsy.

Women with epilepsy were more likely to have experienced family illness, divorce, homelessness, partner losing a job, reduced work or pay, increased arguments, having a partner in jail, drug use, and the death of someone close to them.

The results showed that unmarried and younger women as well as those with lower incomes were particularly prone to experience stress during pregnancy.

It's not clear why women with epilepsy report more stressors. "Looking at the literature, no one has really looked at the exact reason for this, but we postulate it could be a lack of supports and support systems," said Chaudhry.

Women were asked about physical, sexual, and emotional abuse. Results showed that substantially more women with epilepsy than those without the disorder reported such abuse during pregnancy ― 10.6% vs 4.1%. The adjusted odds ratio for women with epilepsy reporting abuse was 2.78 (95% CI, 2.07 – 3.74).

"That raises our concern and needs to be looked at in more in detail," said Chaudhry.

It's unclear whether some women might have had psychogenic non-epileptic seizures (PNES), which are linked to a higher rate of abuse, said Chaudhry. "But the prevalence of PNES in the general population is quite low, so we don't think it's contributing to a large extent to this finding."

The findings highlight the importance of addressing stress in women with epilepsy during pregnancy, he said. "We need to have good support services and we need to counsel women to optimize good outcomes."

This applies to all women of childbearing age. "We suspect abuse and stressors are going to be going on throughout that period," said Chaudhry. "It's important to ask about it and have appropriate support staff and social work and people available to help when an issue is identified."

Stress a Common Seizure Trigger

Commenting for Medscape Medical News, Kimford Meador, MD, professor, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, noted the study was well conducted and had a large sample size.

The findings are important as stress is a common trigger for seizures in people with epilepsy and is associated with mood and anxiety, which can affect quality of life, said Meador.

Results of his analysis from the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study, also presented at this year's AES meeting, showed that women with epilepsy had more depressive symptoms during the postpartum period and more anxiety symptoms during pregnancy and postpartum in comparison with those without epilepsy.

Meador's group also recently conducted a study that was published in JAMA Neurology showing that anxiety in women with epilepsy during the postpartum period is associated with lower cognitive ability in their children at age 2 years.

"All these findings highlight the importance of assessing and managing stress, anxiety, and mood in women with epilepsy," said Meador. "Interventions could impact seizures and quality of life in pregnant women with epilepsy, and long-term outcomes in their children."

American Epilepsy Society (AES) 75th Annual Meeting 2021: Abstract 2.135. Presented December 5, 2021.

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