Life Stressors During Pregnancy in Women With Epilepsy

Abstract

Objective:To compare specific life stressors and domestic abuse that pregnant women with epilepsy (WWE) experience compared to pregnant women without epilepsy (WWoE).Methods:The Pregnancy Risk Assessment Monitoring System (PRAMS) is an annual weighted survey of randomly sampled postpartum women administered by the Centers for Disease Control (CDC). We used data from PRAMS from 2012-2020 in 13 states to assess the life stressors reported by WWE compared to WWoE. We adjusted the data for maternal age, race, ethnicity, marital status, education, and socioeconomic status (SES; using income, WIC, and Medicaid use). We also examined reported abuse in WWE compared to WWoE.Results:This study included data from 64,951 postpartum women, representing 4,072,189 women through weighted sampling. Of these, 1,140 reported having a diagnosis of epilepsy in the 3 months prior to their pregnancies (representing 81,021 WWE). WWE experienced a higher number of stressors compared to WWoE. WWE were more likely to have experienced 9 out of the 14 stressors asked in the PRAMS questionnaire: severe illness of a close family member, separation or divorce, homelessness, loss of a partner’s job, cut in work hours or pay, arguing more than usual with their partner, serving jail time, substance abuse problem in a close contact, and death of a close contact. After adjusting for demographics (age, race, and SES), epilepsy was still associated with a higher number of stressors in pregnant women. Other factors associated with stressors were younger age, Indigenous or mixed race, non-Hispanic ethnicity, lower income, and WIC or Medicaid use. Those who were married were less likely to report stressors. WWE were also more likely to report abuse before or during their pregnancies.Conclusions:While managing stress is important in both epilepsy and pregnancy, WWE experience more stressors than do WWoE. After adjusting for maternal age, race, and SES, this increase in stressors persisted. Women who were younger, with lower income, on WIC or Medicaid, or not married also were more likely to experience life stressors. Alarmingly, reported abuse was also higher in WWE compared to WWoE. Attention from clinicians and support services for WWE is needed to optimize good pregnancy outcomes.