Increased primary cesarean delivery rate among people with epilepsy: Risks, drivers and future directions

Abstract

People with epilepsy are at increased risk of hemorrhage-related severe maternal morbidity (SMM) events, but little is known about the prevalence and drivers of cesarean births – a major contributor to hemorrhage – in this population. We therefore examined if cesarean birth differed among people with versus without epilepsy, and whether any differences were explained by patient or hospital level factors. This cohort study used linked birth certificate and hospital discharge data from nulliparous, term, singleton, vertex (NTSV) livebirths in California from 2007-2018 to compare the prevalence of cesarean birth among people with versus without epilepsy. Epilepsy was defined using diagnosis codes and categorized into generalized, focal, and other less specified subtypes. Poisson regression models with robust standard errors were conducted adjusting for potential confounders; sociodemographic factors, clinical factors, and hospital characteristics, to examine the rate of cesarean birth. Subgroup analyses were conducted replicating these models among each epilepsy subtype. Of 1,550,586 NTSV births in California from 2007-2018, 5,027 (0.3%) were among people with epilepsy. People with epilepsy had higher rates of hypertensive disorders of pregnancy and pre-existing diabetes (P < 0.001, Table 1). People with epilepsy versus those without had higher risk of cesarean birth (32.1% vs 26.6%, risk ratio [RR] 1.21 [95% CI 1.16-1.25], Table 2). Despite adjusting for sociodemographic, clinical and hospital factors, the significant increase in cesarean birth among people with epilepsy persisted (aRR 1.18 [95% CI 1.13-1.23]). When stratified into subgroups, the increased risk of cesarean birth was most pronounced for less specified epilepsies (aOR1.18 [95% CI 1.13 – 1.23]). Despite adjustment for sociodemographic, clinical, and hospital factors, primary cesarean births were significantly increased in people with epilepsy. Given the known hemorrhage-related SMM risks in people with epilepsy, targeting the primary cesarean birth rate may aid in risk reduction in this population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)