Objective To investigate whether women with epilepsy have an increased risk of complications during pregnancy and to explore the impact of antiepileptic drug (AED) use.Design Population-based cohort study.Setting Data from Medical Birth Registry of Norway based on all births in Norway 1999-2005.Population All births (n = 372 128) delivered in Norway, ensured through linkage with the National Population Registry run by Statistics Norway. All singleton births and the first child in multiple pregnancies were included, leaving 365 107 pregnancies for analyses.Main outcome measures Pre-eclampsia (mild and severe), gestational hypertension, eclampsia, vaginal bleeding (early and late) and preterm birth.Results We compared 2805 pregnancies in women with a current or past history of epilepsy (0.8%) and 362 302 pregnancies in women without a history of epilepsy. Women with epilepsy had an increased risk of mild pre-eclampsia, [odds ratio 1.3: 95% confidence interval (1.1-1.5)] and delivery before week 34 [1.2: (1.0-1.5)]. Antiepileptic drugs were used in 33.6% (n = 942) of the pregnant women with epilepsy. Compared to women without epilepsy, women with epilepsy and AED use had an increased risk of mild pre-eclampsia [1.8: (1.3-2.4)], gestational hypertension [1.5: (1.0-2.2)], vaginal bleeding late in pregnancy [1.9: (1.1-3.2)], and delivery before 34 weeks of gestation [1.5: (1.1-2.0)]. No significant increase in the risk of these complications was observed in women with epilepsy not using AED. These results remained unchanged after exclusion of multiple pregnancies.Conclusion Women with epilepsy have a low complication rate, but special attention should be paid to those using AED during pregnancy.

Objective To report the complications during pregnancy and delivery in women with epilepsy, compared with a control group without epilepsy, with special focus on potential risk factors, such as epilepsy severity and dosage of antiepileptic drugs.Design Hospital-based retrospective study.Setting Data from pregnancy notification forms and hospital case records.Population Women with a past or present history of epilepsy (n = 205) delivered in Bergen, Norway, in the period 1999-2006, and a matched control group of women (n = 205) without epilepsy.Methods Data were compared and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by multiple logistic regression models.Main outcome measures Pre-eclampsia (mild and severe), gestational hypertension, vaginal bleeding (early and late), caesarean section, vaginal operative delivery, postpartum haemorrhage and major malformations.Results Women with epilepsy using antiepileptic drugs had an increased risk of severe pre-eclampsia (OR, 5.0; 95% CI, 1.3-19.9), bleeding in early pregnancy (OR, 6.4; 95% CI, 2.7-15.2), induction (OR, 2.3; 95% CI, 1.2-4.3) and caesarean section (OR, 2.5; 95% CI, 1.4-4.7) adjusted for maternal age, parity, education, smoking, medical conditions and body mass index ‡30 kg/m 2 . There was also an increased risk of malformations in the offspring (OR, 7.1; 95% CI, 1.4-36.6). Women without antiepileptic drug use had increased risks of forceps delivery and preterm birth. Active epilepsy (seizures during the last 5 years) versus nonactive epilepsy did not discriminate for any of these complications; 84.5% of women with epilepsy and antiepileptic drug use were using folate.Conclusion Women with epilepsy using antiepileptic drugs had an increased risk of pregnancy and delivery complications, whereas women not using antiepileptic drugs had few complications. Seizures, high doses of antiepileptic drugs, obesity and lack of folate could not explain these increased risks.Keywords Antiepileptic drugs, delivery, epilepsy, pregnancy.Please cite this paper as: Borthen I, Eide M, Daltveit A, Gilhus N. Obstetric outcome in women with epilepsy: a hospital-based, retrospective study. BJOG 2011;118:956-965.

Please cite this paper as: Borthen I, Eide M, Daltveit A, Gilhus N. Delivery outcome of women with epilepsy: a population‐based cohort study.
BJOG 2010;117:1537–1543. Objective  To investigate whether women with epilepsy have increased risks of complications during labour, and to explore the impact of antiepileptic drug use. Design  Population‐based cohort study. Setting  Data from the Medical Birth Registry of Norway 1999–2005. Population  All births (n = 372 128) delivered in Norway, ensured through linkage with the National Population Registry run by Statistics Norway. All singleton births and the first child in multiple pregnancies were included, leaving 365 107 pregnancies for analysis. Methods  Data from the Medical Birth Registry of Norway 1999–2005 were analysed. Main outcome measures  Induction, caesarean section, use of forceps and vacuum, abnormal presentation, placental abruption, mechanical disproportion, postpartum haemorrhage, atony and Apgar score < 7 after 5 minutes. Results  We compared 2805 pregnancies in women with a current or past history of epilepsy (0.8%) and 362 302 pregnancies in women without a history of epilepsy. Antiepileptic drugs were used in 33.6% (n = 942) of pregnant women with epilepsy. Women with epilepsy had an increased risk of induction [odds ratio (OR), 1.3; 95% confidence interval (CI), 1.1–1.4], caesarean section (OR, 1.4; 95% CI, 1.3–1.6) and postpartum haemorrhage (OR, 1.2; 95% CI, 1.1–1.4) compared with women without epilepsy. These rates were even higher for women with epilepsy and antiepileptic drug use, with ORs (95% CIs) of 1.6 (1.4–1.9), 1.6 (1.4–1.9) and 1.5 (1.3–1.9), respectively. In addition, the risk of an Apgar score < 7 was higher (OR, 1.6; 95% CI, 1.1–2.4). For women with epilepsy without antiepileptic drug use, only a slightly increased risk of caesarean delivery was observed and no increased risk for any other complications studied. Conclusions  Pregnant women with epilepsy have a low complication rate; however, they have a slightly increased risk of induction, caesarean section and postpartum haemorrhage. It is not possible to ascertain on the basis of this study whether this is a result of more severe epilepsy or antiepileptic drug use.