Do women with epilepsy have more fear of childbirth during pregnancy compared with women without epilepsy? A case-control study

Sex and gender differences in epilepsy

Sex and gender differences in epilepsy are important influencing factors in epilepsy care. In epilepsy, the hormonal differences between the sexes are important as they impact specific treatment considerations for patients at various life stages particularly during early adulthood with establishment of the menstrual cycle, pregnancy, perimenopause and menopause. Choice of antiseizure medication may have direct consequences on hormonal cycles, hormonal contraception, pregnancy and fetal risk of major congenital malformation. Conversely hormones whether intrinsic or extrinsically administered may have direct impact on antiseizure medications and seizure control. This chapter explores these important influences on the management of persons with epilepsy.

Prevalence of self-reported emotional, physical, and sexual abuse and association with fear of childbirth in pregnant women with epilepsy: The Norwegian Mother, Father, and Child Cohort Study

OBJECTIVE

This study was undertaken to examine the prevalence of self-reported experiences with abuse in pregnant women with epilepsy and the association between having experienced abuse and childbirth expectations, particularly the fear of childbirth.

METHODS

We performed a cross-sectional study of women with and without epilepsy enrolled in the Norwegian Mother, Father, and Child Cohort Study 1999-2008. Data on epilepsy diagnosis; antiseizure medication (ASM) use; emotional, physical, and sexual abuse; and childbirth expectations were collected from questionnaires completed during gestational Weeks 17-19 and 30.

RESULTS

Our study population included 295 women with ASM-treated epilepsy, 318 women with ASM-untreated epilepsy, and 93 949 women without epilepsy. A total of 115 women (47%) with ASM-treated and 132 women (57%) with ASM-untreated epilepsy reported any emotional, physical, or sexual abuse, compared to 25 100 women (32%) without epilepsy. The adjusted odds ratios (aORs) for having experienced any abuse were 1.8 (95% confidence interval [CI] = 1.4-2.3) and 1.8 (95% CI = 1.4-2.2) for ASM-treated and ASM-untreated epilepsy, respectively. A total of 29 women (11%) with ASM-treated and 34 women (11%) with ASM-untreated epilepsy reported having been raped, compared to 3088 women (4%) without epilepsy (aORs = 2.8 [95% CI = 1.8-4.1] and 2.9 [95% CI = 2.0-4.2], respectively). In nulliparous women with ASM-untreated epilepsy, having experienced abuse was associated with fear of childbirth; 22 women (31%) with abuse experiences reported fear of childbirth compared to five women (7%) with no experience of abuse (aOR = 5.4 [95% CI = 1.7-17.2]). This association was not seen in multiparous women or in women with ASM-treated epilepsy.

SIGNIFICANCE

More women with epilepsy reported emotional, physical, and sexual abuse than women without epilepsy. Such experiences may be associated with childbirth expectations.

Parenting Fears and Concerns during Pregnancy: A Qualitative Survey

Previous research on the fears and anxieties of expectant mothers has focused mostly on their fears about giving birth rather than parenting. This study aims to describe mothers' fears and concerns about parenthood during pregnancy and to examine the similarities and differences in the perspectives of primiparous and multiparous mothers. The qualitative research for this study was conducted in three postpartum units in Finland and focused on the responses to an open-ended question about parenting fears and concerns that was part of a questionnaire given to 250 mothers after they had given birth. The responses from the 128 mothers who answered this question were subject to inductive content analysis. Fears and concerns on parenthood included worries about coping with the future and everyday life with their new baby, the psychological burden of parenthood, their maternal resources and self-efficacy, meeting their baby's needs, their baby's health, concerns about their relationship with their partner and financial issues. Primiparous and multiparous mothers shared many of the same concerns, but some differences emerged. The findings contribute an interesting perspective to the social debate about declining birth rates and their psychosocial causes. Further studies are needed to examine the fears and concerns of younger adults, and even teens, about parenthood.

Epilepsy and pregnancy: What should the neurologists do?

Epilepsy is one of the most common chronic disorders affecting women of childbearing age. Unfortunately, many women with epilepsy (WWE) still report not receiving key information about pregnancy. They obviously need information about epilepsy and pregnancy prior to conception with a particular emphasis on effective birth control (i.e. contraception), necessity to plan pregnancy, antiepileptic drugs optimization, and folate supplementation. The risks associated with use of antiepileptic drugs during pregnancy have to be balanced against fetal and maternal risks associated with uncontrolled seizures. This report reviews evidence-based counseling and management strategies concerning maternal and fetal risks associated with seizures, teratogenic risks associated with antiepileptic drug exposure with a special emphasis on developmental and behavioural outcomes of children exposed to intra utero antiepileptic drugs.

The effect of distraction techniques on pain and stress during labor: a randomized controlled clinical trial

Background

Pain control and the stress associated with labor and delivery are among the most important issues of health care system. Use of distraction techniques during childbirth is reported to reduce pain and stress of labor. However, there is a limited publication that looked on the effect of distraction techniques on labor pain and stress. Thus, the aim of this study was to determine the effect of distraction techniques on labor pain and stress (primary outcomes), fear of childbirth, length of delivery stages, first minute Apgar score and oxytocin consumption (secondary outcomes).

Methods

A randomized controlled clinical trial was conducted on 68 pregnant women. Participants were allocated into two groups (intervention and control groups) by blocked randomization. Participants in the intervention group received distraction techniques in four sessions. Questionnaires of Fear of Childbirth (W-DEQ version A) and PSS once were completed before intervention and again at the 36th week for the W-DEQ and in the active phase for the PSS through interviews. The pain was assessed through VAS during active phase per hour. The length of delivery stages was recorded in the partograph chart. Data were analyzed by independent t-test and ANCOVA.

Results

The mean of perceived stress during labor in the intervention group was significantly less than that of the control group (AMD: -3.2; 95% CI: − 0.8 to − 6.0; P = 0.01). The mean (SD) of pain intensity during labor was less than in the intervention and control groups compare to the control group (6.2 vs 7.5; P < 0.001). There was no significant difference between the two groups in terms of fear of childbirth score (AMD: 5.3; 95% CI: 13.0 to − 6.0; P = − 2.3). Moreover, there was no statistically significant difference between the two groups in terms of the active phase of labor (P = 0.504), second stage of delivery (P = 0.928), total length of delivery (P = 0.520), Apgar score (P = 1.000) and frequency of oxytocin consumption (P = 0.622).

Conclusion

According to the results, distraction techniques can reduce the pain and stress of labor, but further studies by using the distraction techniques are needed to reach a decisive conclusion.

Trial registration

IRCT2017042910324N39; Name of registry: Iranian Registry of Clinical Trials; Registered 11 September 2017. URL of registry: https://fa.irct.ir/user/trial/10814/view. Date of enrolment of the first participant to the trial: September 2017.

Fear and Anxiety Disorders Related to Childbirth: Epidemiological and Therapeutic Issues

PURPOSE OF REVIEW

This paper seeks to identify the risk factors of fear of childbirth (FOC) and posttraumatic stress disorder (PTSD) related to birth and reviews the efficacy of their respective screening tools and therapeutic interventions.

RECENT FINDINGS

Biofeedback, hypnosis, internet-based cognitive behavioral therapy, and antenatal education are promising treatments for FOC. Training midwives to address traumatic birth experiences could help in preventing PTSD. A shorter more pragmatic screening tool for FOC than the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ) is needed. Women with PTSD attributed a mismatch between the expected mode of delivery (MOD) and the actual MOD as the cause of their trauma. A history of mental health disorders, lack of social support, previous negative birth experiences, and MOD are correlated to FOC and postpartum PTSD. Psycho-education and CBT-based treatments have been found to reduce levels of FOC and PTSD.

Exploring the perception of women with epilepsy about pregnancy concerns: a qualitative study

Background and aim

Epilepsy is a common neurological disorder in pregnancy, which is associated with increased maternal and fetal adverse outcomes. This study aimed to explore the reproductive healthcare needs of women with epilepsy before, during and after childbirth.

Methods

This was a qualitative study using a content analysis method. The study population was marital women with epilepsy in reproductive age (15–45 years) referred to Imam Hossein Hospital, Tehran, Iran. Participants were 16 women chosen using purposive sampling with the consideration of maximum variation in sampling. Semi-structured interviews were held with the participants until data saturation was reached. The data were analyzed using the content analysis method. The MAXQDA software, version 2010, was used for the management of data.

Results

The data analysis led to the development of two categories. The first one is named ‘resilience against threats to safe pregnancy’ and has the following subcategories: (1) real physical complications and perceived (mental) conditions due to unwanted pregnancies, (2) the predisposing factors of anxiety related to safe pregnancy, (3) perceived consequences of pregnancy’, and (4) the approach to encounter perceived consequences of pregnancy. The second category is called ‘adverse experiences under inefficient supportive systems’ and has the following subcategories: (1) the insufficiency of reproductive healthcare services for women with epilepsy, (2) doubt about the advantages and disadvantages of breastfeeding, (3) stigma as a block to the treatment of the postpartum depression, and (4) playing the motherhood role under the shadow of self-esteem to lack of self-esteem.

Conclusion

In the prenatal, natal and postnatal duration, because of supportive system disruption and not receiving proper consultation, participants were often worried about not being able to get favorable conditions for safe pregnancy and controlling process of their pregnancy. Therefore, they often experienced unwanted pregnancy. They were also concerned about the adverse fetal outcomes. In postpartum period, they often experienced postpartum depression and were very doubtful about breastfeeding.

Alterations in pain responsiveness and serum biomarkers in juvenile myoclonic epilepsy: an age- and gender-matched controlled pilot study

Introduction: Serum levels of several biomarkers along with sensory responsiveness were investigated in juvenile myoclonic epilepsy patients in comparison with healthy controls. Methods: Ten epileptic patients (36.1 ± 3.4 years) and ten gender- and age-matched healthy controls were recruited. Mechanical sensitivity, cold pressor tolerance and serum levels of BDNF, CGRP, PGE2, S100B and TNF-α were investigated. Results: Mechanical sensitivity to pinprick was lower in patients (p < 0.05) while cold pain tolerance threshold was higher. Serum level of BDNF was higher in patients compared with controls (p < 0.01). The same pattern was evident for CGRP (p < 0.05). Serum level of PGE2 was lower in patients (p < 0.01). Conclusion: Juvenile myoclonic epilepsy patients had an altered serum biomarker pattern and sensory perception in comparison with controls.

Beyond medical diagnosis: Factors contributing to life satisfaction of women with epilepsy in Israel

This study was an exploratory study aimed to examine the contribution of both objective variables (such as education, occupational status, and leisure activity) and subjective variables (such as perceived disability, body image, and feminine self-image) to the life satisfaction of women with epilepsy in Israel. The study also sought to compare the findings with earlier studies of women with epilepsy or other disabilities in order to identify similar patterns in their life satisfaction. The study included 70 women, who had applied in the past to the Israel Epilepsy Association to obtain information and leisure activities. They were asked about their degree of life satisfaction in the context of their personal data including occupational status, leisure activity, perceived disability, body image, and feminine self-image. Findings indicated that higher education and perception of body image and femininity were positively correlated with higher life satisfaction. The regression model showed that perceived severity of disability and body image had the highest contribution to satisfaction with life, a fact that attests to the paramount importance of women's perception of their health disability in dealing with the disorder. These findings are discussed in relation to earlier comparative studies of those with/without epilepsy. The implications for practice suggest aspects that ought to be included in therapeutic interventions such as including contents related to feminine self-image and body image in the rehabilitation process as well as recommendations for future studies.

Is antiepileptic drug withdrawal status related to quality of life in seizure-free adult patients with epilepsy?

PURPOSE

This study aimed to determine factors that influence the quality of life (QOL) of seizure-free adult patients with epilepsy in western China and address whether these determinants vary by antiepileptic drug (AED) withdrawal.

METHODS

A cross-sectional study was conducted in the epilepsy outpatient clinic of West China Hospital, Sichuan University. Patients with epilepsy who were aged at least 18years and seizure-free for at least 12months were interviewed using the Quality of Life in Epilepsy Inventory-31 (QOLIE-31); the National Hospital Seizure Severity Scale (NHS3); the Liverpool Adverse Events Profile (LAEP); the Social Support Rating Scale (SSRS); the Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) Questionnaire; and the Scale of Knowledge and Attitudes Toward Epilepsy. Eligible patients were divided into two groups: the nonwithdrawal group and the withdrawal group. The independent-samples t-test was used to compare the QOL between the groups, and linear regression analysis was used to explain the variance of their QOL.

RESULTS

One hundred and eighty-seven (135 nonwithdrawal and 52 withdrawal) patients were included in the analysis. The QOLIE-31 overall score of the nonwithdrawal group was lower than that of the withdrawal group (p<0.01). The LAEP score was the strongest predictor of the QOLIE-31 overall score of all subjects, explaining 26.9% of the variance. The second strongest predictor was the SSRS score, explaining 12.9%, and the other predictors were the NHS3 score (5.2%), education level (2.3%), age (1.5%), and marriage (1.0%). Furthermore, the strongest predictors in the nonwithdrawal group were the LAEP and SSRS scores, while in the withdrawal group, the strongest predictors were stigma scores and employment.

CONCLUSION

Among the seizure-free adult patients with epilepsy, those with AED withdrawal experienced better QOL than those continuing AED treatment. Furthermore, the determinants of QOL varied by AED withdrawal. Individual strategies to optimize QOL should be developed based on these differences.

Psychiatric comorbidity and social aspects in pregnant women with epilepsy - the Norwegian Mother and Child Cohort Study

OBJECTIVE

The objective of this study was to investigate psychiatric disease and social aspects in young women with epilepsy before and during pregnancy.

METHOD

The study included self-reported data from 106,935 pregnancies.

RESULTS

Seven hundred eleven women reported having epilepsy, and 45.9% of them were using antiepileptic drugs (AEDs). Compared to the reference group, self-reported eating disorders and depression were increased in the untreated epilepsy group before pregnancy. Both AED-treated and untreated women with epilepsy reported higher depression scores as assessed by the Hopkins Symptom Checklist, and the Lifetime Major Depression scale was increased in AED-treated women. Antiepileptic drug treatment was linked to low income (27.4% vs. 18.4%, p<0.001) and no income (5.5% vs. 2.6%, p=0.001). Low educational level was associated with epilepsy in AED-treated and untreated women (50.5%, p<0.001 and 46.9%, p<0.001 vs. 32.2%), as was unemployment due to disability (7.9%, p<0.001 and 6.5%, p<0.001 vs. 1.5%) and single parenting (4.4%, p=0.016 and 4.5%, p=0.007 vs. 2.4%). No difference was found for smoking, alcohol use, or narcotic use.

CONCLUSION

Symptoms of depression were associated with epilepsy both during and before pregnancy. Epilepsy was linked to eating disorders before pregnancy. Unemployment, single parenting, and low educational level were linked to epilepsy in young pregnant females. Efforts aiming at treatment and screening for psychiatric comorbidity in pregnant women with epilepsy are important in the follow-up of these patients.

Women living with epilepsy, experiences of pregnancy and reproductive health: a review of the literature

PURPOSE

This study aimed to investigate the experiences of pregnancy in women living with epilepsy through a review and synthesis of existing literature.

METHODS

A comprehensive search of the literature was conducted in medical and social science databases to identify qualitative research, and questionnaires that included open-ended questions, which reported on the impact of epilepsy on the lives of pregnant women from preconception to post-delivery. The search was widened to include qualitative studies on pregnancy and issues of reproduction with women living with chronic illness that had at least one woman with epilepsy in the sample. The systematic search, carried out from April to June 2012, identified 17 publications that met the inclusion criteria, and 24 publications that did not. Qualitative results from these studies were categorised into: stage of pregnancy (preconception, pregnancy, and postnatal); case studies of patients' experiences; and the reproductive health experiences of women living with chronic illness.

RESULTS

One qualitative study was identified that directly investigated women's experiences of epilepsy during pregnancy. Many of the findings from the 16 remaining publications were found to be limited in generalisability due to small sample sizes and/or the poor quality of data.

CONCLUSION

Qualitative research on women's experiences of pregnancy whilst living with epilepsy is needed to address this critical gap in knowledge. This paper calls for improved preconception, pregnancy and postnatal supports and information for women living with this condition.

Risk perception and medicines information needs in pregnant women with epilepsy--a qualitative study

PURPOSE

To explore risk perception and medicines information needs in pregnant women with epilepsy (WWE).

METHOD

In-depth interviews with pregnant WWE treated with antiepileptic drugs (AEDs).

RESULTS

Ten women aged 22-39 years in 20-34 weeks' gestation were interviewed. Avoiding seizures by taking AEDs in pregnancy outweighed perceived risks, but dose adjustments during and after pregnancy increased perceived risks of teratogenicity or seizures. The women had restrictive attitudes towards taking medicines for other indications than epilepsy. They appreciated their neurologist as a source for medicines information, though their needs for medicines information were reduced by long-term use of AEDs.

CONCLUSIONS

Pregnant WWE were confident in using AEDs through communication with their neurologist, but dose adjustments caused concern. Medicines information to pregnant WWE should focus on empowering the women to control the disease, supporting realistic risk perceptions of AEDs and other necessary medicines. In this article, we outline some medicines information strategies to pregnant WWE.

Determinants of quality of life in people with epilepsy and their gender differences

Improving the patient's quality of life (QOL) is the most important goal of epilepsy management. We performed this study to determine the factors associated with QOL in people with epilepsy and to assess whether there are gender differences in these determinants. Patients were interviewed using the Quality of Life in Epilepsy Inventory-31(QOLIE-31), the Adverse Event Profile (AEP), the Self-Rating Anxiety Scale (SAS), and the Hamilton Depression Rating Scale (HAMD). Two hundred forty-seven patients (152 men, 95 women) were included in the analysis. Among all patients, regressive analyses showed that AEP score was the strongest predictor of the QOLIE-31 overall score, accounting for 10.4% of the variance. The next strongest predictors were the number of currently used antiepileptic drugs (AEDs) (3.6%), the HAMD score (2.5%), and the SAS score (1.2%). Importantly, there were gender differences in these predictors of QOL. The strongest predictors of the QOLIE-31 overall score in women were the AEP score and the number of AEDs. In contrast, the strongest predictors in men were the SAS score, the AEP score and the frequency of seizures. These results indicate that perceived adverse effects of treatments and number of AEDs exerted greater effects on QOL in women, whereas anxiety and seizure-related variables had a stronger impact on QOL among men. Accordingly, it may be necessary to individualize interventions to improve the QOL of people with epilepsy.