Generalized and focal epilepsy and pregnancy, delivery and neonatal outcomes: a retrospective cohort study

We previously demonstrated associations between maternal epilepsy and pregnancy outcomes. Now, we seek to determine whether these outcomes differ between generalized and focal epilepsy. A retrospective cohort study was completed using the HCUP-NIS database. Pregnancy outcomes were compared across generalized and focal epilepsy types, as determined via ICD-9 codes. Of 2,596 pregnancies, 1978 women had focal epilepsy and 618 had generalized epilepsy. Focal epilepsy was associated with increased rates of cesarean sections as compared to generalized epilepsy (aOR = 1.27;95 %CI = 1.02-1.57;p = 0.030). Other pregnancy outcomes did not differ significantly, including pregnancy induced hypertension, gestational hypertension, preeclampsia, eclampsia, preeclampsia and eclampsia superimposed on pre-existing hypertension, gestational diabetes mellitus, placenta previa, preterm premature rupture of membranes, preterm delivery, abruptio placenta, chorioamnionitis, operative vaginal delivery, hysterectomy, postpartum hemorrhage, wound complications, maternal death, transfusion, maternal infection, deep venous thrombosis, pulmonary embolism, venous thromboembolism, disseminated intravascular coagulation, small for gestational age, intrauterine fetal demise and congenital anomalies (P > 0.05, all). As compared to generalized epilepsy, focal epilepsy was associated with younger age (p < 0.001), lower income quartile (p = 0.013), tobacco smoking during pregnancy (p = 0.037) and illicit drug use (p < 0.001). Women with focal epilepsy were more likely than those with generalized epilepsy to be covered by Medicaid and less likely to be covered through Medicare or private insurance (p < 0.001). No significant differences were observed regarding other maternal characteristics. Women with focal epilepsy are at a higher risk of delivery through cesarean section than those with generalized epilepsy. The reason why remains unclear. Reassuringly, other pregnancy complications are not increased by generalized as opposed to focal epilepsy.