Maintaining Seizure Freedom during Pregnancy and Postpartum: Findings from the MONEAD Study (S11.001)

Publication Type
Journal Article
Year of Publication
2018
Authors
Page Pennell; French, Jacqueline; May, Ryan; Gerard, Elizabeth; Kalayjian, Laura; Gedzelman, Evan; Penovich, Patricia; Cavitt, Jennifer; Hwang, Sean; Pack, AlisonM; Sam, Maria; Moore, Eugene; Ippolito, Dominic; Meador, Kimford
Secondary
Neurology
Volume
90
Date Published
04/2018
Keywords
AAN/AES Pregnancy Parameters; Epilepsy; pregnant; PWWE; The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD); women
Abstract

Objective:

To analyze the likelihood of maintaining seizure freedom during pregnancy and postpartum, with comparison to non-pregnant women with epilepsy over the same time interval.

Background:

The AAN/AES Pregnancy Parameters concluded there is insufficient evidence to determine if seizure frequency changes occur in pregnant women with epilepsy (PWWE), because the appropriate gold standard comparator group, non-pregnant WWE (NPWWE), has not been employed. Prior studies suggested WWE who were seizure-free ≥9 months prior to pregnancy have a high likelihood of remaining seizure-free during pregnancy.

Design/Methods:

The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is an NIH-funded, prospective, observational, multi-center investigation of pregnancy outcomes for mother and child. MONEAD enrolled 351 PWWE, and 109 NPWWE were enrolled to maintain group balance with PWWE on age, race, ethnicity, baseline seizure frequency and AED regimen. For PWWE, the number of seizures prior to enrollment but after conception through day of delivery were included in the pregnancy seizure rates.

Results:

In the PWWE group, 164/351 (46.7%) were seizure free for the 9 months preceding pregnancy. For the NPWWE group, 49/109 (45.0%) were seizure free for the 9 months prior to enrollment. Of these seizure-free women at baseline, 139 (84.8%) PWWE remained seizure free during pregnancy and 144 (87.8%) during the 9 months postpartum; 42 (85.7%) NPWWE remained seizure free for 9 months following enrollment, and 41 (83.7%) in the subsequent 9 months.

Conclusions:

This is the first study to compare seizure frequency changes in PWWE to NPWWE. Our findings suggest low risk of seizure recurrence during pregnancy for women who were seizure free prior to conception, and did not differ compared to NPWWE. Future analyses will include seizure frequency changes in all WWE, with analysis of potential risk factors, including type and dosing of AEDs, seizure types, time to last seizure, and specific time windows (e.g., peripartum).