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Published online before print November 18, 2009, doi:10.1212/WNL.0b013e3181c3f27d)
© 2009 American Academy of Neurology Obstetric outcomes in women with multiple sclerosis and epilepsyFrom the Department of Medicine (V.M.K.), Division of Epidemiology, Department of Health Research and Policy (L.M.N.), and Division of Immunology and Rheumatology, Department of Medicine (E.F.C.), Stanford University School of Medicine, Stanford, CA. Address correspondence and reprint requests to Dr. Eliza F. Chakravarty, 1000 Welch Road, Ste. 230, MC 5755, Stanford, CA 94304; echakravarty{at}stanford.edu Objective: To estimate the national occurrence of pregnancies in women with multiple sclerosis (MS) and epilepsy and to compare these pregnancy outcomes cross-sectionally with those in women with pregestational diabetes mellitus (DM) and the general obstetric population. Methods: We studied the 2003–2006 Nationwide Inpatient Sample, of the Healthcare Cost and Utilization Project, to estimate the number of deliveries in women with MS, epilepsy, DM, and the general obstetric population. Pregnancy outcomes included length of hospital stay, hypertensive disorders including preeclampsia (HTN), premature rupture of membranes (PROM), intrauterine growth restriction (IUGR), and cesarean delivery. Multivariable regression analyses used maternal age and race/ethnicity as covariates. Results: Of an estimated 18.8 million deliveries, 10,055 occurred in women with MS, 4,730 with epilepsy, and 187,239 with DM. MS was associated with mildly increased odds of antenatal hospitalization (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.2–1.5), IUGR (OR 1.7, 95% CI 1.2–2.4), and cesarean delivery (OR 1.3, 95% CI 1.1–1.4). Similarly, epilepsy was associated with increased rates of antenatal hospitalization (OR 3.0, 95% CI 2.6–3.5), IUGR (OR 1.9, 95% CI 1.2–3.3), and cesarean delivery (OR 1.5, 95% CI 1.3–1.9). HTN and PROM were not increased in either group. DM was associated with an increased risk of all adverse outcomes. Length of stay was modestly increased in all groups compared with controls. Conclusion: In this large national database study of pregnancy outcomes in women with multiple sclerosis and epilepsy, rates of intrauterine growth restriction and cesarean delivery were only marginally higher than the general obstetric population without increases in other adverse outcomes.
Abbreviations: AED = antiepileptic drug; CI = confidence interval; DM = diabetes mellitus; HTN = hypertensive disorders including preeclampsia; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; IUGR = intrauterine growth restriction; LOS = length of hospital stay; MS = multiple sclerosis; NIS = Nationwide Inpatient Sample; OR = odds ratio; PROM = premature rupture of membranes.
e-Pub ahead of print on November 18, 2009, at www.neurology.org. Disclosure: Author disclosures are provided at the end of the article. Received April 12, 2009. Accepted in final form August 20, 2009.
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