The Obstetrical Care and Delivery Experience of Women with Epilepsy in the MONEAD Study

被引:12
作者
McElrath, Thomas F. [1 ]
Druzin, Maurice [2 ]
Van Marter, Linda J. [3 ]
May, Ryan C. [4 ]
Brown, Carrie [4 ]
Stek, Alice [5 ]
Grobman, William [6 ]
Dolan, Mary [7 ]
Chang, Patricia [8 ]
Flood-Schaffer, Kellie [9 ]
Parker, Lamar [10 ]
Meador, Kimford J. [12 ]
Pennell, Page B. [11 ]
机构
[1] Brigham & Womens Hosp, Harvard Med Sch, Dept Obstet & Gynecol, Div Maternal Fetal Med, 75 Francis St, Boston, MA 02115 USA
[2] Stanford Univ, Dept Obstet & Gynecol, Div Maternal Fetal Med, Palo Alto, CA 94304 USA
[3] Johns Hopkins All Childrens Hosp, Dept Pediat, Div Newborn Med, St Petersburg, FL USA
[4] Emmes, Washington, DC USA
[5] Univ Southern Calif, Dept Obstet Gynecol, Los Angeles, CA 90007 USA
[6] Northwestern Univ, Div Maternal Fetal Med, Dept Obstet & Gynecol, Chicago, IL 60611 USA
[7] Emory Univ, Div Maternal Fetal Med, Dept Obstet & Gynecol, Atlanta, GA 30322 USA
[8] Minnesota Epilepsy Grp, Dept Obstet Gynecol, St Paul, MN USA
[9] Univ Cincinnati, Dept Obstet Gynecol, Cincinnati, OH USA
[10] Wake Forest Univ, Dept Obstet Gynecol, Winston Salem, NC 27101 USA
[11] Univ Pittsburgh, Sch Med, Dept Neurol, Pittsburgh, PA 15261 USA
[12] Stanford Univ, Dept Neurol, Stanford, CA 94305 USA
关键词
cesarean; epilepsy; seizure; prenatal care;
D O I
10.1055/a-1788-4791
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective We examined mode of delivery among pregnant women with epilepsy (PWWE) versus pregnant controls (PC). We hypothesize that PWWE are more likely to deliver by cesarean.Study Design The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is an observational, prospective, multicenter investigation of pregnancy outcomes funded by the National Institute of Health (NIH). MONEAD enrolled patients from December 2012 through January 2016. PWWE were matched to PC in a case:control ratio of 3:1. This analysis had 80% power to detect a 36% increase in cesarean frequency assuming a baseline rate of 30% among PC at an alpha = 0.05.Results This report analyzed 331 PWWE (76%) and 102 PC (24%) who gave birth while enrolled in the study. PWWE and PC had similar rates of cesarean delivery (34.7 vs. 28.6%; p = 0.27). Of women with cesarean, rates of cesarean without labor were similar between groups for those delivering in recruitment hospitals (48.2 vs. 50.0%) but in nonrecruitment hospitals, cesarean rates without labor were over two-fold higher among PWWE than those of PC (68.8 vs. 30.8%; p = 0.023). Receipt of a cesarean after labor did not differ for PWWE compared to PC or by type of antiepileptic drug among the PWWE.Conclusion These findings suggest that the obstetrical experiences of PWWE and PC are similar. An interesting deviation from this observation was the mode of delivery with higher unlabored cesarean rates occurring among PWWE in nonrecruitment hospitals. As the study recruitment hospitals were tertiary academic centers and nonrecruitment hospitals tended to be community-based institutions, differences in perinatal expertise might contribute to this difference.
引用
收藏
页码:935 / 943
页数:9
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