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Abstract
Background and Objectives To compare specific life stressors and domestic abuse that pregnant women and others with epilepsy (WWE) experience compared with pregnant women and others 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 and Prevention. We used data from the PRAMS from 2012 to 2020 in 13 states to assess the life stressors reported by WWE compared with WWoE. We adjusted the data for maternal age, race, ethnicity, marital status, education, and socioeconomic status (SES; using income, Women, Infants, and Children program [WIC], and Medicaid use). We also examined reported abuse in WWE compared with 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 before their pregnancies (representing 81,021 WWE). WWE experienced a higher number of stressors compared with WWoE. WWE were more likely to have experienced 9 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.
Discussion Although 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 were also more likely to experience life stressors. Alarmingly, reported abuse was also higher in WWE compared with WWoE. Attention from clinicians and support services for WWE are needed to optimize good pregnancy outcomes.
Glossary
- ASD=
- antiseizure drug;
- CDC=
- Centers for Disease Control and Prevention;
- IRR=
- incidence rate ratio;
- PNES=
- psychogenic nonepileptic seizure;
- PRAMS=
- Pregnancy Risk Assessment Monitoring System;
- SES=
- socioeconomic status;
- WIC=
- Women, Infants, and Children program;
- WWE=
- women and others with epilepsy;
- WWoE=
- women and others without epilepsy
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Associate Editor Barbara Jobst, MD, PhD, FAAN.
Editorial, page 1121
CME Course: NPub.org/cmelist
- Received March 3, 2022.
- Accepted in final form February 23, 2023.
- © 2023 American Academy of Neurology
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