Herzog AG, et al. - Experts evaluated the link between planned pregnancy and spontaneous fetal loss (SFL) in women with epilepsy. Findings suggested that the risk for SFL may be doubled by unplanned pregnancy in women with epilepsy.

Methods

• This web-based, retrospective survey was conducted by the Epilepsy Birth Control Registry between 2010 and 2014.
• Demographic, epilepsy, antiepileptic drug (AED), contraceptive, and reproductive data was gathered from 1,144 women with epilepsy in the community between ages 18 and 47 years.
• Researchers analyzed the data between March 2018 and May 2018.
• The risk ratio (RR) with 95% confidence intervals for SFL in unplanned vs planned pregnancies was the primary outcome.
• The identification of potentially modifiable variables (maternal age, pregnancy spacing, and AED category) of SFL vs live birth using binary logistic regression was the secondary outcome.

Results

• As per data, the participants were proportionally younger (mean [SD] age, 28.5 [6.8] years), and 39.8% had household incomes of $25,000 or less.
• Findings suggested that minority women represented only 8.7% of the participants.
• They noted that 530 of 794 were unplanned pregnancies (66.8%) and 264 of 794 were planned pregnancies (33.2%).
• In 653 unaborted pregnancies in women with epilepsy, a greater risk for SFL was seen in unplanned (n=137 of 391; 35.0%) vs planned (n=43 of 262; 16.4%) pregnancies (RR, 2.14; 95% CI, 1.59-2.90; P < .001).
• They noted greater risk for SFL when planning was entered alone (odds ratio [OR], 2.75; 95% CI, 1.87-4.05; P < .001) and more so when adjusted for maternal age, interpregnancy interval, and AED category (OR, 3.57; 95% CI, 1.54-8.78; P=003), as seen in regression analysis.
• An association of interpregnancy interval (OR, 2.878; 95% CI, 1.8094-4.5801; P=.008) with maternal age (OR, 0.957; 95% CI, 0.928-0.986 for each year from 18 to 47 years; P=.02), but not AED category, was seen.
• They noted greater risk when interpregnancy interval was less than 1 year (n=56 of 122; 45.9%) vs greater than 1 year (n=56 of 246; 22.8%) (RR, 2.02; 95% CI, 1.49-2.72; P < .001).
• Relative to the younger than 18 years cohort (n=15 of 29; 51.7%), for the intermediate older cohort aged 18 to 27 years (n=118 of 400; 29.5%; RR, 0.57; 95% CI, 0.39-0.84;P< .004) and the cohort aged 28 to 37 years (n=44 of 212; 20.8%; RR, 0.40; 95% CI, 0.26-0.62;P<.001) the risks were lower but not significantly different for the small number of participants in the aged 38 to 47 years cohort (n=3 of 12; 25.0%).
• Results did not demonstrate any significant difference in the individual AED category’s SFL frequency from the no AED category.