Seizure patterns, preconception care and pregnancy outcomes in women with epilepsy in a tertiary care hospital

Abstract

INTRODUCTION AND OBJECTIVES: Data on epilepsy in pregnancy is limited from South Asia and other resource-limited countries. We sought to describe seizure patterns, preconception care and pregnancy outcomes in women with epilepsy attending a Sri Lankan tertiary care hospital. METHOD: All pregnant women with epilepsy admitted to University Obstetrics Unit, Colombo North Teaching Hospital during the period January 2017 February 2020 were recruited. Data were collected by a single physician using an interviewer-administered questionnaire. RESULTS: Out of 9520 pregnant women screened, 63 had a history of epilepsy (prevalence 6.6/1000); 46% generalized epilepsy, 22.2% focal epilepsy. Of 38 women on antiepileptics at conception, only 44.7% were given folic acid 5 mg preconceptionally. 42.9% were seizure free over preceding 2 years. Majority (55%) had a seizure during current pregnancy (average number of seizures per patient: 1s1 trimester 1.85, 2nd trimester 2.2, 3rd trimester 2.95, postpartum 2.5). 18.4% of seizure events were attributed to sleep deprivation, and 2.7% to unsatisfactory drug compliance. 81.6% were on monotherapy at conception and 18.4% were on two antiepileptic. 22.2% had a hypertensive disorder of pregnancy and 9.5% spontaneous premature delivery. 33.3% underwent caesarian delivery. 1.58% each had a stillbirth and neonatal death. Low birth weight was seen in 42.9%. Major congenital malformations were found in 11.1% of newborns. CONCLUSIONS: Pre-conceptional folic acid coverage was poor. Seizures occurred in more than half of the women and were more common in third trimester and postpartum. Rates of hypertensive disorders, caesarean deliveries, low birth weight and congenital malformations were high.