Our objective was to describe differences in outcomes of pregnancies and other risk factors related to worse outcomes in women with epilepsy based upon socioeconomic disparities in an urban population of Detroit, Michigan.

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A retrospective analysis was performed on all women with epilepsy who attended a high risk epilepsy and pregnancy clinic in Detroit Medical Center from August 2013 through April 2021. Data was collected on demographic variables including zip code, insurer, seizure history, anti-seizure medications (ASMs), pregnancy outcomes and neonatal outcomes. Pregnancies were classified on socioeconomic status (SES) by mother’s zip code using the annual median household income data from the publicly available 2020 US census data and categorized as low SES (income < $35,000) or high SES (income ≥$35,000). Descriptive analysis was performed to compare outcomes and variables between these groups.

138 pregnancies were identified in a cohort of 126 unique women. 75 pregnancies were in the low SES cohort and 84% were Black and 1.33% were White compared to 63 pregnancies in the higher SES of which 60.3% were Black and 31.7% were White. Pregnancies who were insured by Medicaid was 62.5% in the lower SES cohort versus 50.8% in the higher SES cohort.

In regards to pregnancy outcomes, the lower SES cohort saw a greater number of miscarriages (8%) and premature deliveries (11%) compared to the higher SES cohort (6.4% and 7.9%, respectively). Among neonates, 5.3% experienced RDS and 5.3% experienced sepsis in the lower SES cohort compared to 3.2% RDS and 1.6% in the higher SES cohort.

Women with epilepsy who become pregnant may have complications related to higher rates of prematurity and are less likely to have planned pregnancies and use folic acid pre-conceptually. Public awareness amongst health officials and providers can focus on these vulnerable populations to improve pregnancy outcomes in WWE.