The Rate of and Factors Associated with Delivery by Caesarean Section among Women with Epilepsy: Time Trend in a Single-Centre Cohort in Mazovia, Poland

Abstract

Data from literature suggest that the rate of caesarean section (CS) in women with epilepsy (WWE) is higher than in the general population. In Poland, there is neither a national registry nor another data set to access the outcome of pregnancy in WWE. Therefore, we address this gap by prospectively studying CS rates among 1021 WWE pregnancies at a single centre, their trends over time, and factors increasing the likelihood of the CS. To determine whether the diagnosis of epilepsy itself increased this likelihood, mixed models were used to analyse the contributions of specific variables, including the presence of seizures at different pregnancy-related timepoints. Over 20 years, the mean rate of CS in WWE was progressively growing and was higher than in the general population in Mazovia (47% vs. 32%). Generalized seizures in the third trimester increased the likelihood of CS with the highest odds (OR 4.4). The most frequent indication for a CS was obstetric (58.1%), followed by epilepsy-related (25.2%). Almost half of women who indicated epilepsy as the sole reason for CS had no seizure during pregnancy, and nearly 70% did not have generalized seizures. This suggests the overuse of epilepsy as an indication of CS and encourages defining more strict criteria.

Keywords: antiseizure treatment; caesarean delivery; pregnancy; seizures; women with epilepsy.

Figure 1

Linear regression of caesarean section rate by year for patients in the epilepsy centre (WWE) and the general population of Mazovia County.

Figure 2

Likelihood of caesarean section according to the occurrence of generalized seizures pre-pregnancy, throughout the entire pregnancy, and in the 3rd trimester. Odds ratios (ORs) for caesarean section are presented as a forest plot with corresponded 95% confidence interval.