Fertility rate and pregnancy outcomes of epileptic women at the neurology clinic in Kenyatta national hospital

Abstract

Background: Reproductive health issues of women with epilepsy are complex and multifaceted. As a chronic and sometimes lifelong disease, epilepsy is particularly intertwined with all aspects of a woman's reproductive health. Both epilepsy and antiepileptic medications may have effects on reproductive health. Objective: To determine the fertility rate and pregnancy outcomes of epileptic women of reproductive age (l5-49years) attending the neurology clinic at Kenyatta national hospital. Study design: Cross-sectional study. Setting: Neurology clinic, Kenyatta national hospital, Nairobi, Kenya. Study population: Women of reproductive age (l5-49years) who had been epileptic for at least one year. Methods: Epileptic women of reproductive age were interviewed regarding their pregnancy ,,;!1 and birth histories, and the information validated with medical records where available. Results: A total of 191 epileptic women were consecutively recruited into the study over a five-month period (October 2006 and March 2007). The 191 epileptic women had given birth to a total of 173 livebirths as at June 2006. 94 and 79 livebirths had been born outside and inside epilepsy illness respectively. Ofthe 79 livebi•rths, 34 had been born in the last 5years and 25 in last 3 years preceding the survey. The General Fertility Rate (GFR) of epileptic women aged 15-49yrs for the 3-year period (2003- 2006) preceding the study was 46 livebirths per 1000 women-years (95% CI 35.1311000- 63.5911000). This rate was 2/3rds that reported in the Kenya demographic and health survey (KDHS 2003). The proportion of study women who were pregnant at the time of survey was 2.1%, which, compared to that of the general population (7.8% in the KDHS 2003) was 73.1% lower. No major congenital malformations were reported in the 173 livebirths. The Perinatal Mortality Rate (PMR) for five-year period preceding the study was 132 deaths per 1000 births (95% CI 24.1- 239.1), which was 3.3 times higher than that in the general population (40 deaths/WOObirths). The rate of spontaneous abortion for the 5-year period preceding the study was 17% (95% CI 6.28-27.76). There was no comparative rate in Kenya. As per review of literature, this rate was within that in the general population (12-26%). Conclusion: Fertility rate of women with epilepsy is reduced by 2/3rds and the reasons for this are probably multifactorial. Perinatal mortality rate is 3.3 times higher in epileptic women compared with that in the general population. The rate of spontaneous abortion in WWE is not increased. compared to that in women in general. Recommendation: A study to answer why fertility rate in epileptic women is reduced is highly recommended.