Increased Primary Cesarean Births Among People with Epilepsy: A Population-Based Cohort Study

Area of Science:

• Obstetrics and Gynecology
• Neurology
• Public Health

Background:

• Pregnant individuals with epilepsy have increased risks of severe maternal morbidity.
• Cesarean birth is a significant contributor to severe maternal morbidity.
• Factors influencing cesarean rates in epilepsy patients are not well understood.

Purpose of the Study:

• To determine if nulliparous, term, singleton, vertex (NTSV) live births in people with epilepsy have increased primary cesarean rates.
• To investigate whether sociodemographic, clinical, or hospital factors explain these differences.

Main Methods:

• A cohort study analyzed linked data from NTSV live births in California (2007-2018).
• Epilepsy was identified using ICD-9-CM and ICD-10-CM diagnosis codes.
• Risk ratios (RRs) were calculated to assess the association between epilepsy subtypes and primary cesarean birth, adjusting for confounders.

Main Results:

• People with epilepsy had a higher risk of cesarean birth (32.1% vs. 26.6%, RR: 1.21).
• This increased risk persisted after adjusting for sociodemographic, clinical, and hospital factors (aRR: 1.18).
• The risk was particularly elevated in individuals with unspecified epilepsies.

Conclusions:

• The elevated risk of NTSV cesarean birth in people with epilepsy is not explained by measured factors.
• Unmeasured factors likely contribute to the higher cesarean rates.
• Identifying these factors is crucial for developing strategies to reduce cesarean births and improve maternal outcomes.