Fertility and birth outcomes in women with epilepsy seeking pregnancy

IMPORTANCE Prior studies report lower birth rates for women with epilepsy (WWE) but have been unable to differentiate between biological and social contributions. To our knowledge, we do not have data to informWWE seeking pregnancy if their likelihood of achieving pregnancy is biologically reduced compared with their peers. OBJECTIVE To determine ifWWE without a prior diagnosis of infertility or related disorders are as likely to achieve pregnancy within 12 months as their peers without epilepsy. DESIGN, SETTING, AND PARTICIPANTS TheWomen With Epilepsy: Pregnancy Outcomes and Deliveries study is an observational cohort study comparing fertility inWWE with fertility in control women (CW) without epilepsy. Participants were enrolled at 4 academic medical centers and observed up to 21 months from November 2010 to May 2015.Women seeking pregnancy aged 18 to 40 years were enrolled within 6 months of discontinuing contraception. Exclusion criteria included tobacco use and a prior diagnosis of infertility or disorders that lower fertility. EighteenWWE and 47 CW declined the study, and 40WWE and 170 CWdid not meet study criteria. TheWomen With Epilepsy: Pregnancy Outcomes and Deliveries electronic diary app was used to capture data on medications, seizures, sexual activity, and menses. Data were analyzed from November 2015 to June 2017. MAIN OUTCOMES AND MEASURES The primary outcomewas proportion ofwomen who achieved pregnancy within 12 months after enrollment. Secondary outcomes were time to pregnancy using a proportional hazard model, pregnancy outcomes, sexual activity, ovulatory rates, and analysis of epilepsy factors inWWE. All outcomes were planned prior to data collection except for time to pregnancy. RESULTS Of the 197 women included in the study, 142 (72.1%) were white, and the mean (SD) age was 31.9 (3.5) years among the 89WWE and 31.1 (4.2) among the 108 CW. Among 89 WWE, 54 (60.7%) achieved pregnancy vs 65 (60.2%) among 108 CW. Median time to pregnancy was no different between the groups after controlling for key covariates (WWE: median, 6.0 months; 95%CI, 3.8-10.1; CW: median, 9.0 months; 95%CI, 6.5-11.2; P = .30). Sexual activity and ovulatory rates were similar inWWE and CW. Forty-four of 54 pregnancies (81.5%) inWWE and 53 of 65 pregnancies (81.5%) in CWresulted in live births. No epilepsy factors were significant. CONCLUSIONS AND RELEVANCE Women with epilepsy seeking pregnancy without prior known infertility or related disorders have similar likelihood of achieving pregnancy, time to pregnancy, and live birth rates compared with their peers without epilepsy.