Abstracts

Rationale: Of every 1,000 births in the United States each year, up to five children are born to women with epilepsy. Epilepsy and childbirth are both known independent risk factors for psychiatric comorbidity and need for hospitalization. Our objective was to assess whether having epilepsy is associated with a higher risk of 30-day readmission due to psychiatric illness during the postpartum period. Methods: Postpartum women up to age 50 years were identified in the 2014 Nationwide Readmissions Database, a nationally representative US hospitalization database. Epilepsy was identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for epilepsy in any diagnostic position at or before time of delivery. Admissions for delivery were identified using ICD-9-CM diagnosis and procedure codes. The primary outcome of interest was categorized as: 1) 30-day readmission due to psychiatric illness defined using ICD-9-CM diagnosis codes for depression, psychosis, mania, bipolar disorder, suicidality, anxiety, post-traumatic stress disorder, alcohol and substance abuses, and schizophrenia; 2) 30-day readmission due to all other causes; and 3) No 30-day readmission. The no readmission group was the referent group. The secondary outcome was top 3 causes of psychiatric readmissions based on clinical classification system codes. The key covariate of interest was the presence of epilepsy (yes, no). Baseline covariates were defined at index admission of delivery and subgroup differences between the epilepsy and no epilepsy group were measured using standardized mean difference scores (SMDS). Multinomial logistic regression was performed to examine the association between readmissions due to psychiatric illness and presence of epilepsy after controlling for demographic, hospital characteristics, socioeconomic and clinical factors, including Charlson comorbidity index. Only covariates that demonstrated a >10% SMDS were entered into the model. All analyses were performed using Statistical Analysis Software version 9.4 and accounted for sample design using stratum, cluster and discharge weights to be able to provide national estimates. Results: Of the 1,558,875 women with admissions for delivery, 6,745 (0.45%) had a diagnosis of epilepsy. Mean age was 28.37 years (range: 11-50) in the no-epilepsy group and 27.8 (range: 12-50) in the epilepsy group. In the no-epilepsy group 97.10% of deliveries were single, liveborn deliveries compared with 95.95% in the epilepsy group. One out of every 10,000 women had 30-day psychiatric readmissions in the no-epilepsy vs 13 out of every 10,000 in the epilepsy group (p<0.0001). In the no epilepsy group, 115 out of every 10,000 women had 30-day readmissions due to other causes as compared to 255 out of every 10,000 women in the epilepsy group (p<0.0001). Compared to those without epilepsy, women with epilepsy had higher odds of readmission due to psychiatric illness (OR = 5.90, 95% CI = (3.03, 11.50)) and also due to all other causes (OR = 1.75, 95% CI = (1.47, 2.09)). The top causes of readmissions due to psychiatric illness in women with epilepsy were: mood disorders (59%), schizophrenia and other psychotic disorders (32%), and substance-related disorders (9%). Conclusions: Women with epilepsy have higher odds of readmission due to a psychiatric illness following the birth of a child compared to women without epilepsy. These findings demonstrate the need for increased psychiatric surveillance for women with epilepsy in the peri- and postpartum settings. Funding: No funding