Risk of Bleed During Pregnancy in Women with Epilepsy Due to Cerebral Vascular Malformations

Cerebral vascular malformations are rare but important causes of epilepsy in young women. The risk of bleed during pregnancy and delivery as well as the fetal outcomes are important concerns for women with epilepsy (WWE) due to cerebral vascular malformations (EVM).

We compared the maternal and fetal outcomes of a cohort of EVM with women with focal epilepsy due to other causes (ENVM).

We identified all EVMs in the Kerala Registry of Epilepsy and Pregnancy and compared their characteristics with that of a set of randomly selected ENVM in the same registry. The clinical characteristics, pregnancy outcome, and seizure risk during pregnancy from the vascular malformations were compared between the two groups with Chi-square test and multivariate logistic regression after adjustment for age, epilepsy classification, and AED usage.

There were 45 women with EVM (arteriovenous malformations: 25, cavernoma: 20) in this registry between 1998 and 2018. The EVM and ENVM groups (n = 96) had similar rates of seizure relapse during pregnancy (37.1% vs. 55.1%), fetal loss (11.4% vs. 13.5%), and fetal malformations (9.4% vs. 9%). The rate of delivery by cesarean section, adjusted for maternal age, was higher for the EVM group (61.2% vs. 39%, odds ratio = 2.79, 95% CI: 0.99-7.9, P = 0.05). AVM bled during pregnancy for three women (none of the cavernoma had bled during pregnancy).

Maternal and fetal outcomes were comparable for the EVM and ENVM groups, but the former had a higher rate of cesarean section. AVM bled during pregnancy for 15% of women.