513: Obstetric outcomes for women receiving newer generation antiepileptic drugs: retrospective cohort study using claims database

Abstract

Women with epilepsy are at increased risk for adverse pregnancy outcomes. Since the 1990s, over 11 new antiepileptic drugs (AEDs) have been introduced. We aimed to describe the use of newer AEDs in pregnancy and differences in rates of obstetric outcomes. From the Truven Health MarketScan® Commercial Claims and Encounters Database (years 2011-14), we identified women who had a delivery admission, outpatient pharmacy dispenses for newer generation AEDs (Table) and an indication of epilepsy based on diagnosis codes during the 12 months prior to delivery. Obstetric outcomes included preterm birth, cesarean delivery, postpartum hemorrhage, placental abruption, hypertensive disorders of pregnancy, preterm labor, and severe maternal morbidity (SMM). We described the prevalence of the use of newer AEDs and rates of obstetric outcomes and absolute risk difference compared to women without a diagnosis of epilepsy (Table). In the cohort analyzed (n=1,028,125), the prevalence of epilepsy was 0.44% (n=4,528). Overall, 55% (n=2,508) received any of these AEDs during pregnancy, the most common of which were lamotrigine (49.8%) and levetiracetam (42.5%). Compared to the non-epileptic control group, women on AEDs showed significant increases in the absolute risk of cesarean delivery (5.0%), preeclampsia (0.7%), severe preeclampsia/eclampsia (0.9%) and SMM (1.6%). AEDs with the highest increases in absolute risk were topiramate (6.7%) for cesarean delivery, lamotrigine for pre-eclampsia (1.1%), and lacosamide for severe preeclampsia/eclampsia (8.4%) and SMM (9.3%). Of the 2,508 women, 414 (16.5%) received more than one AED during pregnancy. Compared to women receiving a single AED, those who received multiple AEDs had higher absolute risks of all outcomes except postpartum hemorrhage (Table). Compared to non-epileptic women, women on newer generation AEDs demonstrated an increased absolute risk for cesarean delivery, preeclampsia, severe preeclampsia/eclampsia and severe maternal morbidity. Women receiving multiple medications demonstrated the highest increase in absolute risk for adverse outcomes, similar to findings in older AEDs, possibly also reflecting a more complicated and difficult disease state.