Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, the Division of Neonatal and Developmental Medicine, Department of Pediatrics, and the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Obstet Gynecol. 2021 Nov 1;138(5):747-754. doi: 10.1097/AOG.0000000000004562.
To evaluate severe maternal morbidity (SMM) among patients with epilepsy and patients without epilepsy.
We retrospectively examined SMM using linked birth certificate and maternal hospital discharge records in California between 2007 and 2012. Epilepsy present at delivery admission was the exposure and was subtyped into generalized, focal and other less specified, or unspecified. The outcomes were SMM and nontransfusion SMM from delivery up to 42 days' postpartum, identified using Centers for Disease Control and Prevention indicators. Multivariable logistic regression models were used to adjust for confounders, which were selected a priori. We also estimated the association between epilepsy and SMM independent of comorbidities by using a validated obstetric comorbidity score. Severe maternal morbidity indicators were then compared using the same multivariable logistic regression models.
Of 2,668,442 births, 8,145 (0.3%) were to patients with epilepsy; 637 (7.8%) had generalized, 6,250 (76.7%) had focal or other less specified, and 1,258 (15.4%) had unspecified subtypes. Compared with patients without epilepsy, patients with epilepsy had greater odds of SMM (4.3% vs 1.4%, adjusted odds ratio [aOR] 2.91, 95% CI 2.61-3.24) and nontransfusion SMM (2.9% vs 0.7%, aOR 4.16, 95% CI 3.65-4.75). Epilepsy remained significantly associated with increased SMM and nontransfusion SMM after additional adjustment for the obstetric comorbidity score, though the effects were attenuated. When grouped by organ system, all SMM indicators were significantly more common among patients with epilepsy-most notably those related to hemorrhage and transfusion.
Severe maternal morbidity was significantly increased in patients with epilepsy, and SMM indicators across all organ systems contributed to this.
评估癫痫患者与非癫痫患者的严重孕产妇发病率（SMM）。
我们在 2007 年至 2012 年期间，使用加利福尼亚州的出生证明和产妇住院记录进行了 SMM 的回顾性检查。分娩时存在的癫痫为暴露因素，并分为全身性、局灶性和其他非特异性或未特异性。结局为分娩至产后 42 天内的 SMM 和非输血性 SMM，采用疾病控制与预防中心的指标进行识别。使用多变量逻辑回归模型调整混杂因素，这些因素是预先选择的。我们还使用经过验证的产科合并症评分，估计了癫痫与 SMM 之间的关联，而不考虑合并症。然后使用相同的多变量逻辑回归模型比较癫痫与 SMM 指标。
在 2668442 例分娩中，有 8145 例（0.3%）为癫痫患者；637 例（7.8%）为全身性，6250 例（76.7%）为局灶性或其他非特异性，1258 例（15.4%）为未特异性。与非癫痫患者相比，癫痫患者 SMM 的几率更高（4.3% vs 1.4%，调整后的优势比[aOR]2.91，95%CI2.61-3.24）和非输血性 SMM（2.9% vs 0.7%，aOR 4.16，95%CI3.65-4.75）。在进一步调整产科合并症评分后，癫痫与 SMM 和非输血性 SMM 仍显著相关，尽管影响有所减弱。当按器官系统分组时，所有 SMM 指标在癫痫患者中更为常见-尤其是与出血和输血相关的指标。
癫痫患者的严重孕产妇发病率显著增加，所有器官系统的 SMM 指标均对此有贡献。
