Perinatal & Pediatric
ASSOCIATION BETWEEN SEVERE MATERNAL MORBIDITY AND EPILEPSY IN CHILDREN: A POPULATION BASED BIRTH COHORT STUDY. Bénédicte Driollet* Bénédicte Driollet Emmalin Buajitti Asma Ahmed Jennifer Hutcheon Laura Rosella Seungmi Yang
Introduction. Severe maternal morbidity (SMM) has shown to be associated with adverse perinatal outcomes. However, its association with the emergence of pediatric neurodevelopmental disorders is scarce, particularly with epilepsy, whose etiology is poorly understood. Thus, this study aims to investigate the effect of severe maternal morbidity on the risk of epilepsy in offspring.
Methods. We included all children born in hospitals between 2002 and 2018 in Ontario, Canada, with a follow-up until March 2020. Epilepsy diagnosed before 18 years and SMM were defined using administrative health datasets. We estimated the crude and the adjusted risk of epilepsy associated with SMM, using a Cox model, and examined the robustness of results using quantitative bias analyses.
Results. Of the 2 060 317 children (mean gestational age 38.9 weeks (SD 1.7)), 17 853 were diagnosed with epilepsy within a median follow-up time of 10 years, and 40 830 were exposed to SMM. In a model adjusted for maternal, birth, and area-level characteristics, children exposed to SMM had, at any time after birth, a 48% increase in risk of diagnosis of epilepsy compared to those unexposed (aHR:1.48, 95%CI 1.35-1.62). The risk of epilepsy increased to 70% in children whose mothers were exposed to severe pre-eclampsia, HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome, and eclampsia (aHR:1.70, 95%CI 1.36-2.13), 3 most frequent and preventable subtypes of SMM.
Conclusion. In this population-based birth cohort study, our findings suggest that SMM is associated with an increased risk of epilepsy in children. These results open new perspectives in understanding neurodevelopmental diseases in children and underline the importance of ensuring a healthy pregnancy. Monitoring and evaluation of the development of children exposed to SMM may be deemed necessary.