The maternal postnatal six-week check in women with epilepsy: Does the prevalence or subsequent postpartum health differ from the general postnatal population?

Abstract

Objectives: To examine the prevalence of the maternal postnatal six-week check (SWC) in women with epilepsy compared to a sample of the postnatal population without epilepsy, and assess whether the SWC is associated with health outcomes in the first year postpartum.

Methods: Clinical Practice Research Datalink Aurum and Hospital Episode Statistics data were used to identify births between January1998-March2020 to women with epilepsy (n = 23,533) and a random sample of births to women without epilepsy (n = 317,369). The adjusted risk ratio (aRR) for not having a SWC in women with compared to without epilepsy was estimated using modified Poisson regression. The association between receiving a SWC and postpartum health outcomes was assessed using Cox regression.

Results: The likelihood of not having a SWC did not differ between those with and without epilepsy (42.7% vs 43.4%, aRR = 1.01, 95%CI = 0.99-1.03). Among all women, not having a SWC was associated with a lower subsequent likelihood of being prescribed prophylactic (aHR = 0.59, 95%CI = 0.58-0.60) and emergency (aHR = 0.95, 95%CI = 0.91-0.99) contraception and having urinary and/or faecal incontinence (aHR = 0.67, 95%CI = 0.61-0.73) or dyspareunia, perineal and/or pelvic pain (aHR = 0.70, 95%CI = 0.65-0.75) recorded in the year postpartum, with no evidence these associations differed according to whether a woman had epilepsy. Not having a SWC was also associated with a lower likelihood of having depression and/or anxiety recorded in the first year postpartum among those without (aHR = 0.86, 95%CI = 0.84-0.89) but not with epilepsy (aHR = 1.01, 95%CI = 0.93-1.09). The SWC was not associated with epilepsy relevant outcomes (Accident and emergency visits or unplanned hospital admission for epilepsy, mortality).

Conclusions: Around 2 in every 5 women had no evidence of a maternal SWC, with no evidence epileptic women had a different prevalence to the general postnatal population. The maternal SWC may play a role in increasing the use of contraception and the detection or treatment of adverse health outcomes in the first year postpartum.

Fig 1. Percentage of pregnancies to women with and without epilepsy who had evidence of a maternal SWC over time. Abbreviations: SWC, postnatal six-week check.