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National database shows marginal increase in risk of intrauterine growth restriction, cesarean delivery among pregnant women with MS, epilepsy, no increase in risk of other adverse outcomes

Wednesday, December 09 2009 | Comments

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What's This? Pregnant women with multiple sclerosis (MS) or epilepsy seem to have an increased risk of intrauterine growth restriction (IUGR) and cesarean delivery relative to the general obstetric population, according to an analysis of a large U.S. database. However, the database did not show an increased risk of other adverse pregnancy outcomes, such as preeclampsia and premature rupture of membranes (PROM).

Researchers at Stanford University analyzed 4 years of hospitalization data from the Nationwide Inpatient Sample (NIS). They calculated the national occurrence of antenatal and delivery hospitalizations from 2003 through 2006, and the proportions of these for which there was a diagnosis of MS or epilepsy in the discharge record. They also compared pregnancy outcomes (hypertensive disorders [eg, preeclampsia], PROM, IUGR, cesarean delivery, and length of hospital stay) among women with MS, women with epilepsy, women with pregestational diabetes (ie, another chronic disease with a known increased risk of adverse pregnancy outcomes), and the general obstetric population (ie, women without MS, epilepsy, or diabetes).

Extrapolating from the database, the researchers estimated that there were 15.2 million deliveries in the United States from 2003 through 2006, including 7,697 deliveries in women with MS, 2,745 in women with epilepsy, and 112,650 in women with diabetes.

In analyses adjusted for maternal age and race/ethnicity, women with MS and epilepsy were more likely to have an antenatal hospitalization (odds ratio [OR], 1.3; 95% CI, 1.2-1.5 and OR, 3.0; 95% CI, 2.6-3.5, respectively), IUGR (OR, 1.7; 95% CI, 1.2-2.4 and OR, 1.9; 95% CI, 1.2-3.3), and a cesarean delivery (OR, 1.3; 95% CI, 1.1-1.4 and OR, 1.5; 95% CI, 1.3-1.9) relative to controls in the general obstetric population. However, neither disease was associated with an increased risk of hypertensive disorders or PROM.

Diabetes was associated with an increased risk of all adverse outcomes, with ORs ranging from 1.2 for PROM (95% CI, 1.1-1.3) to 4.5 (95% CI, 4.4-4.7) for hypertensive disorders.

All 3 chronic-disease groups had a modestly increased length of stay relative to controls, even after adjustment for higher rates of cesarean delivery.

The authors acknowledged that their analysis lacked certain information, including data from obstetric care administered in the outpatient setting and information about potentially important confounding variables, but they concluded that the overall results of this analysis "are reassuring for women with MS and epilepsy." (Kelly VM, et al. Neurology 2009;73:1831-1836.)

In an accompanying editorial, Dr. Gary Franklin with the University of Washington and Helen Tremlett with the University of British Columbia noted that the information provided in this analysis about the impact of epilepsy on pregnancy is limited by a lack of information about antiepileptic drug (AED) use and the potential for misclassification of women with epilepsy in hospital discharge records (ie, a failure to identify epilepsy in women without seizures or those not taking AEDs).

However, they asserted that the current analysis offers some important insight into the effects of MS on pregnancy, an area of research for which data are lacking.

Overall, the editorialists concluded, this and other population-based studies suggest that "there are discernable and reproducible effects of MS on outcomes of pregnancy (increased cesarean section, slightly smaller babies), but they are relatively minor in terms of effect on health of the child." (Neurology 2009;73:1820-1822.)

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