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. 2025 Jun 12;96(7):621-629.
doi: 10.1136/jnnp-2024-335751.

Association of seizure control during pregnancy with adverse offspring outcomes in women with epilepsy

Yutong Fu #  1 , Fanfan Shi #  2 , Leihao Sha  1 , Weihong Lin  3 , Ying Ma  4 , Hua Yan  5 , Pei Wang  6 , Jiajia Fang  7 , Qun Huang  8 , Fang Chen  9 , Xiaoyi Li  10 , Yun Li  11 , Changqing Liu  12 , Qingxia Kong  13 , Hua Huang  14 , Qi Zhang  15 , Rong Mei  16 , Yuan Wu  17 , Shixu He  18 , Yanbing Han  19 , Hua Zhang  20 , Bo Xiao  21 , Kuiyun Wang  22 , Zhanghui Peng  23 , Xi Zhu  24   25 , Jian Wang  26 , Xunyi Wu  27 , Yanmei Zhu  28 , Ting Wu  29 , Xuelian He  30 , Haizhi Guo  31 , Ming Yu  32 , Min Zhong  33 , Qing Zhang  34 , Xiangshu Hu  35 , Yan Su  36 , Mei Zou  37 , Jian Zhou  38 , Yaqing Liu  39 , Bozhong Pu  40 , Chonglun Guo  41 , Qin Feng  42 , Jing Gao  43 , Wanhui Lin  44 , Torbjörn Tomson  45 , Lei Chen  46
Affiliations

Association of seizure control during pregnancy with adverse offspring outcomes in women with epilepsy

Yutong Fu et al. J Neurol Neurosurg Psychiatry. .

Abstract

Background: Information on fetal risks with maternal seizures during pregnancy is scarce. This study investigates seizure control during pregnancy and fetal risks associated with maternal seizures in different stages of pregnancy among pregnant women with epilepsy (PWWE).

Methods: The nested case-control study enrolled PWWE between 2009 and 2023 in China. Information was obtained on maternal seizures, antiseizure medication (ASM), folic acid supplementation and pregnancy outcomes. The primary outcome was composite including major congenital malformations (MCMs), neurodevelopmental delay, low birth weight (LBW) and fetal death. Univariate and multivariate logistic regression analyses were conducted to adjust for ASM effects and other confounders.

Results: Among 1110 pregnancies from 934 PWWE included, 56.6% experienced seizures. Seizure deterioration during pregnancy compared with prepregnancy was observed in 25.9% of pregnancies, while 20.9% experienced worsening seizures from the first to second or third trimesters. Seizures (adjusted OR (aOR) 1.472, 95% CI 1.024 to 2.137), particularly status epilepticus (aOR 2.906, 95% CI 1.364 to 5.93), generalised tonic-clonic seizures (aOR 1.581, 95% CI 1.066 to 2.354) and seizure deterioration (aOR 1.829, 95% CI 1.233 to 2.69) were associated with composite adverse outcomes. Specifically, seizures occurring (aOR 2.324, 95% CI 1.320 to 4.084) or deteriorating (aOR 2.396, 95% CI 1.471 to 3.866) during second and third trimesters were associated with the risk of LBW. No significant association was found between seizures and MCMs.

Conclusions: While nearly half of PWWE remain seizure-free during pregnancy, those who do experience seizures face increased risks of adverse offspring outcomes. For PWWE, every effort should be made to optimise seizure control in order to minimise risks to both mother and child.

Trial registration number: ChiCTR2100046318.

Keywords: EPIDEMIOLOGY; EPILEPSY; SEIZURES.

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Conflict of interest statement

Competing interests: TT has served as a speaker for Eisai, UCB, Angelini and GlaxoSmithKline and received research support to EURAP the International Antiepileptic Drugs and Pregnancy Registry from Bial, Eisai, GlaxoSmithKline, Teva, GW Pharma, Angelini, UCB, Zentiva, Glenmark Accord, SF Group and EcuPharma. None of the other authors have any conflict of interest to disclose.