Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 May 1;80(5):484-494.
doi: 10.1001/jamaneurol.2023.0148.

Comparison of Perinatal Outcomes for Women With and Without Epilepsy: A Systematic Review and Meta-analysis

Paolo Pierino Mazzone  1   2   3 , Kirsty Mhairi Hogg  4 , Christopher J Weir  1   5 , Jacqueline Stephen  5   6 , Sohinee Bhattacharya  7 , Richard F M Chin  1   4   5   2   3
Affiliations
Meta-Analysis

Comparison of Perinatal Outcomes for Women With and Without Epilepsy: A Systematic Review and Meta-analysis

Paolo Pierino Mazzone et al. JAMA Neurol. .

Erratum in

  • Errors in Tables 2 and 3.
    [No authors listed] [No authors listed] JAMA Neurol. 2024 Jun 1;81(6):663. doi: 10.1001/jamaneurol.2024.1248. JAMA Neurol. 2024. PMID: 38683563 Free PMC article. No abstract available.

Abstract

Importance: Pregnant women who have epilepsy need adequate engagement, information, and pregnancy planning and management to improve pregnancy outcomes.

Objective: To investigate perinatal outcomes in women with epilepsy compared with women without epilepsy.

Data sources: Ovid MEDLINE, Embase, CINAHL, and PsycINFO were searched with no language or date restrictions (database inception through December 6, 2022). Searches also included OpenGrey and Google Scholar and manual searching in journals and reference lists of included studies.

Study selection: All observational studies comparing women with and without epilepsy were included.

Data extraction and synthesis: The PRISMA checklist was used for abstracting data and the Newcastle-Ottawa Scale for risk-of-bias assessment. Data extraction and risk-of-bias assessment were done independently by 2 authors with mediation conducted independently by a third author. Pooled unadjusted odds ratios (OR) or mean differences were reported with 95% CI from random-effects (I2 heterogeneity statistic >50%) or fixed-effects (I2 < 50%) meta-analyses.

Main outcomes and measures: Maternal, fetal, and neonatal complications.

Results: Of 8313 articles identified, 76 were included in the meta-analyses. Women with epilepsy had increased odds of miscarriage (12 articles, 25 478 pregnancies; OR, 1.62; 95% CI, 1.15-2.29), stillbirth (20 articles, 28 134 229 pregnancies; OR, 1.37; 95% CI, 1.29-1.47), preterm birth (37 articles, 29 268 866 pregnancies; OR, 1.41; 95% CI, 1.32-1.51) and maternal death (4 articles, 23 288 083 pregnancies; OR, 5.00; 95% CI, 1.38-18.04). Neonates born to women with epilepsy had increased odds of congenital conditions (29 articles, 24 238 334 pregnancies; OR, 1.88; 95% CI, 1.66-2.12), neonatal intensive care unit admission (8 articles, 1 204 428 pregnancies; OR, 1.99; 95% CI, 1.58-2.51), and neonatal or infant death (13 articles, 1 426 692 pregnancies; OR, 1.87; 95% CI, 1.56-2.24). The increased odds of poor outcomes was increased with greater use of antiseizure medication.

Conclusions and relevance: This systematic review and meta-analysis found that women with epilepsy have worse perinatal outcomes compared with women without epilepsy. Women with epilepsy should receive pregnancy counseling from an epilepsy specialist who can also optimize their antiseizure medication regimen before and during pregnancy.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Bhattacharya reported grants from the Medical Research Council outside the submitted work. Dr Chin reported consultant, lecture, and/or conference-attendance fees paid to his institution from Eisai, GW Pharmaceuticals, and Zogenix and owning shares in RIZE Medical Cannabis and Life Sciences. No other disclosures were reported.

Figures

Figure.
Figure.. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 Flow Diagram for New Systematic Reviews That Included Searches of Databases, Registers, and Other Sources
ASM indicates antiseizure medication; WWE, women with epilepsy, WWoE, women without epilepsy.
See this image and copyright information in PMC

References

    1. Meador KJ, Pennell PB, May RC, et al. ; MONEAD Investigator Group . Changes in antiepileptic drug-prescribing patterns in pregnant women with epilepsy. Epilepsy Behav. 2018;84:10-14. doi:10.1016/j.yebeh.2018.04.009 - DOI - PMC - PubMed
    1. Viale L, Allotey J, Cheong-See F, et al. ; EBM CONNECT Collaboration . Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Lancet. 2015;386(10006):1845-1852. doi:10.1016/S0140-6736(15)00045-8 - DOI - PubMed
    1. Chou H-H, Chiou MJ, Liang FW, Chen LH, Lu TH, Li CY. Association of maternal chronic disease with risk of congenital heart disease in offspring. CMAJ. 2016;188(17-18):E438-E446. doi:10.1503/cmaj.160061 - DOI - PMC - PubMed
    1. Christensen J, Vestergaard C, Hammer Bech B. Maternal death in women with epilepsy: smaller scope studies. Neurology. 2018;91(18):e1716-e1720. doi:10.1212/WNL.0000000000006426 - DOI - PMC - PubMed
    1. Danielsson KC, Borthen I, Gilhus NE, Morken NH. The effect of parity on risk of complications in pregnant women with epilepsy: a population-based cohort study. Acta Obstet Gynecol Scand. 2018;97(8):1006-1014. doi:10.1111/aogs.13360 - DOI - PubMed