Barbara M Decker1, Dylan Thibault2, Kathryn A Davis3, Allison W Willis4. 1. Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania School of Medicine, Pennsylvania, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, USA. Electronic address: Barbara.decker@pennmedicine.upenn.edu. 2. Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania School of Medicine, Pennsylvania, PA, USA. 3. Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA. 4. Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania School of Medicine, Pennsylvania, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, USA. Electronic address: Allison.willis2@pennmedicine.upenn.edu.
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 90 days for WWE compared to controls (alpha = 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%, p < 0.0001), alcohol/substance abuse (WWE: 8.3%, controls: 2.5%, p < 0.0001), psychotic disorders (WWE: 1.2%, controls 0.1%, p < 0.0001), and mood disorder (WWE: 15.5%, controls: 3.7%, p < 0.0001). At the time of delivery, WWE were more likely to have edema, proteinuria, and hypertensive disorders (WWE: 19%, controls: 12.9%, p < 0.0001); a history of recurrent pregnancy loss (WWE: 1%, controls: 0.4%, p < 0.0001); preterm labor (WWE: 7.3%, controls: 4.8%, p < 0.0001), or presence of any Center for Disease Control severe maternal morbidity indicator (WWE: 3.2%, controls: 0.6%, p < 0.0001; AOR 5.16, 95% CI 4.70-5.67, p < 0.0001). A higher proportion of WWE were readmitted within 30 days (WWE: 2.4%, controls: 1.1%) and 90 days (WWE: 3.7%, controls: 1.6%). After adjusting for covariates, the odds of postpartum nonelective readmissions within 30 days (AOR 1.86, 95% CI 1.66-2.08, p-value <0.0001) and 90 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.
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 90 days for WWE compared to controls (alpha = 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%, p < 0.0001), alcohol/substance abuse (WWE: 8.3%, controls: 2.5%, p < 0.0001), psychotic disorders (WWE: 1.2%, controls 0.1%, p < 0.0001), and mood disorder (WWE: 15.5%, controls: 3.7%, p < 0.0001). At the time of delivery, WWE were more likely to have edema, proteinuria, and hypertensive disorders (WWE: 19%, controls: 12.9%, p < 0.0001); a history of recurrent pregnancy loss (WWE: 1%, controls: 0.4%, p < 0.0001); preterm labor (WWE: 7.3%, controls: 4.8%, p < 0.0001), or presence of any Center for Disease Control severe maternal morbidity indicator (WWE: 3.2%, controls: 0.6%, p < 0.0001; AOR 5.16, 95% CI 4.70-5.67, p < 0.0001). A higher proportion of WWE were readmitted within 30 days (WWE: 2.4%, controls: 1.1%) and 90 days (WWE: 3.7%, controls: 1.6%). After adjusting for covariates, the odds of postpartum nonelective readmissions within 30 days (AOR 1.86, 95% CI 1.66-2.08, p-value <0.0001) and 90 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.
Authors: Anna I Girsen; Lillian Sie; Suzan L Carmichael; Henry C Lee; Megan E Foeller; Maurice L Druzin; Ronald S Gibbs Journal: J Perinatol Date: 2019-08-28 Impact factor: 2.521
Authors: C L Harden; K J Meador; P B Pennell; W A Hauser; G S Gronseth; J A French; S Wiebe; D Thurman; B S Koppel; P W Kaplan; J N Robinson; J Hopp; T Y Ting; B Gidal; C A Hovinga; A N Wilner; B Vazquez; L Holmes; A Krumholz; R Finnell; D Hirtz; C Le Guen Journal: Neurology Date: 2009-04-27 Impact factor: 9.910