A nationwide analysis of maternal morbidity and acute postpartum readmissions in women with epilepsy.
Epilepsy Behav
; 117: 107874, 2021 04.
Article
in En
| MEDLINE
| ID: mdl-33706248
ABSTRACT
OBJECTIVE:
To compare maternal delivery hospitalization characteristics and postpartum outcomes in women with epilepsy (WWE) versus women without common neurological comorbidities.METHODS:
We performed a retrospective cohort analysis of index characterizations and short-term postpartum rehospitalizations after viable delivery within the 2015-2017 National Readmissions Database using International Classification of Diseases, Tenth Revision codes. Wald chi-squared testing compared baseline demographic, hospital and clinical characteristics and postpartum complications between WWE and controls. Multivariable logistic regression models examined odds of nonelective readmissions within 30 and 90â¯days for WWE compared to controls (alphaâ¯=â¯0.05).RESULTS:
A total of 38,518 WWE and 8,136,335 controls had a qualifying index admission for delivery. Baseline differences were most pronounced in Medicare/Medicaid insurance (WWE 58.2%, controls 43%, pâ¯<â¯0.0001), alcohol/substance abuse (WWE 8.3%, controls 2.5%, pâ¯<â¯0.0001), psychotic disorders (WWE 1.2%, controls 0.1%, pâ¯<â¯0.0001), and mood disorder (WWE 15.5%, controls 3.7%, pâ¯<â¯0.0001). At the time of delivery, WWE were more likely to have edema, proteinuria, and hypertensive disorders (WWE 19%, controls 12.9%, pâ¯<â¯0.0001); a history of recurrent pregnancy loss (WWE 1%, controls 0.4%, pâ¯<â¯0.0001); preterm labor (WWE 7.3%, controls 4.8%, pâ¯<â¯0.0001), or presence of any Center for Disease Control severe maternal morbidity indicator (WWE 3.2%, controls 0.6%, pâ¯<â¯0.0001; AOR 5.16, 95% CI 4.70-5.67, pâ¯<â¯0.0001). A higher proportion of WWE were readmitted within 30â¯days (WWE 2.4%, controls 1.1%) and 90â¯days (WWE 3.7%, controls 1.6%). After adjusting for covariates, the odds of postpartum nonelective readmissions within 30â¯days (AOR 1.86, 95% CI 1.66-2.08, p-value <0.0001) and 90â¯days (AOR 2.04, 95% CI 1.83-2.28, p-value <0.0001) were higher in WWE versus controls.INTERPRETATION:
Women with epilepsy experienced critical obstetric complications and a higher risk of severe maternal morbidity indicators at the time of delivery. Although relatively low, nonelective short-term readmissions after delivery were higher in WWE than women without epilepsy or other common neurological comorbidities. Further research is needed to address multidisciplinary care inconsistencies, improve maternal outcomes, and provide evidence-based guidelines.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Patient Readmission
/
Epilepsy
Type of study:
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Newborn
/
Pregnancy
Country/Region as subject:
America do norte
Language:
En
Journal:
Epilepsy Behav
Journal subject:
CIENCIAS DO COMPORTAMENTO
/
NEUROLOGIA
Year:
2021
Type:
Article