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

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 (I ²heterogeneity statistic >50%) or fixed-effects (I ²< 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, 25478 pregnancies; OR, 1.62; 95% CI, 1.15-2.29), stillbirth (20 articles, 28134229 pregnancies; OR, 1.37; 95% CI, 1.29-1.47), preterm birth (37 articles, 29268866 pregnancies; OR, 1.41; 95% CI, 1.32-1.51) and maternal death (4 articles, 23288083 pregnancies; OR, 5.00; 95% CI, 1.38-18.04). Neonates born to women with epilepsy had increased odds of congenital conditions (29 articles, 24238334 pregnancies; OR, 1.88; 95% CI, 1.66-2.12), neonatal intensive care unit admission (8 articles, 1204428 pregnancies; OR, 1.99; 95% CI, 1.58-2.51), and neonatal or infant death (13 articles, 1426692 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..