From _Medscape Medical News_ (http://www.medscape.com/news)
Women With Multiple Sclerosis or Epilepsy Have Safe Pregnancies
Allison Gandey
November 19, 2009 — New national data suggest that the 2 most common
neurologic disorders affecting women of childbearing age are not stopping
families. "We think that the most important take-home message for clinicians and
women with multiple sclerosis or epilepsy is that pregnancy outcomes are
generally reassuring and not associated with terribly high risks of pregnancy
complications," Eliza Chakravarty, MD, from Stanford University in
California, told Medscape Neurology.
The research team used a nationally representative database of hospitals in
the United States. Of an estimated 18.8 million deliveries, more than
10,000 occurred in women with multiple sclerosis and more than 4700 in women
with epilepsy.
"Intrauterine growth restriction was the only outcome we looked at that was
seen in higher frequency in women with multiple sclerosis or epilepsy,"
said Dr. Chakravarty, the senior investigator on the study. The work was
published online November 18 in Neurology.
In an accompanying editorial, Gary Franklin, MD, from the University of
Washington in Seattle, and Helen Tremlett, PhD, from the University of British
Columbia in Vancouver, call the work "a welcome addition to several recent
population-based studies that shine a little more light on the issue."
Investigators compared national pregnancy outcomes in women with multiple
sclerosis and epilepsy to the general obstetric population and to women with
known high-risk pregnancies due to diabetes mellitus.
Multivariable Odds Ratio (95% Confidence Intervals) for Risk for Adverse
Pregnancy Outcomes Group Hypertensive Disorders Premature Rupture
Intrauterine Growth Restriction Cesarean Delivery Multiple sclerosis 1.1 (0.9
– 1.4) 0.9 (0.7 – 1.3) 1.7 (1.2 – 2.4) 1.3 (1.1 – 1.4) Epilepsy 1.2
(0.9
– 1.7) 0.8 (0.5 – 1.5) 1.9 (1.2 – 3.3) 1.5 (1.3 – 1.9) Diabetes
mellitus
4.5 (4.4 – 4.7) 1.2 (1.1 – 1.3) 1.4 (1.3 – 1.5) 2.9 (2.8 – 3.0)
"The strength of the study is that we were able to look at a large number
of pregnancies over a short time point," said Dr. Chakravarty. "This gives
us a bird's-eye overview of pregnancy outcomes in women with these
relatively rare chronic diseases."
However, she added, "The trade-off for large numbers of subjects is the
relative lack of detail about them. We don't have data on very important
factors associated with pregnancy, such as medication use — a huge issue —
prenatal care, severity of disease, smoking, alcohol, obesity, and past
reproductive history."
The editorialists say that because of these limitations, the data on
epilepsy are of limited use. They argue substantial misclassification was
likely,
resulting in severe underreporting of deliveries and an inability to
consider antiepileptic drugs, which are already linked to adverse birth
outcomes.
"It's hard to get good estimates of how many women with epilepsy have
babies each year," Dr. Chakravarty told Medscape Neurology. "We suspect that
women who have a remote history of epilepsy and who are not taking epilepsy
medications during pregnancy or have not had any seizures during pregnancy
were probably much less likely to have that diagnosis placed on the discharge
summary, so we may have captured the more severe or active end of the
epilepsy spectrum."
Weighing the Risks
Dr. Chakravarty says it will be important to compare these results to other
studies. She said her team was surprised by the lack of data in the
literature about pregnancy outcomes in women with multiple sclerosis. "There
are
excellent studies looking at what a pregnancy does to the course of disease
but very little about what having multiple sclerosis does to a pregnancy."
The editorialists agree that investigators are still a long way from being
able to produce evidence-based practice guidelines in multiple sclerosis,
but they write, "The Stanford group and others, in conducting
population-based studies using existing computerized databases, are beginning
to supply
the critical information needed for this essential task."
"The primary indication is that women should not necessarily be discouraged
from becoming pregnant just because they have a diagnosis of multiple
sclerosis or epilepsy," Dr. Chakravarty added. "As always, each patient should
discuss her individual situation with her doctor so that all of the
potential risk factors can be examined. In cases of chronic diseases, the
medications need to be considered, as well as the disease activity before
conception."
Coauthor Lorene Nelson, PhD, reports having received an honorarium from
BioSymposia Inc and serves on a data safety monitoring board for NeuroPace
Inc.
Neurology. Published online November 18, 2009.
Authors and Disclosures
Journalist
Allison Gandey
Allison Gandey is a journalist for Medscape. She is the former science
affairs analyst for the Canadian Medical Association Journal. Allison, who has
a master of journalism specializing in science from Carleton University,
has edited a variety of medical association publications and has worked in
radio and television. She can be contacted at agandey@....
Medscape Medical News © 2009 Medscape, LLC
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