Seizure control, delivery, and neonatal outcomes in pregnant women with focal epilepsies: a prospective cohort study

Abstract

Objective: To prospectively investigate seizure control during pregnancy in women with focal epilepsies, to assess the impact of specific forms of focal epilepsy (FE) on delivery and neonatal outcomes, and to compare these outcomes with those in pregnancies of women without epilepsy.

Methods: Seventy-nine women with FE, recruited from a large cohort of pregnant women, were prospectively evaluated for over a ten-year period. Seizure, obstetric, and neonatal outcomes were analyzed across the different forms of FE.

Results: Seizures occurred in 77.2 % of women with FE, with higher incidence in frontal lobe epilepsy (FLE) (88.2 %) and temporal lobe epilepsy (TLE) (84.1 %) compared with other focal epilepsies (OFEs) (50.0 %) (p = 0.02 and p = 0.0078, respectively). Women with FLE experienced higher rates of seizure worsening and lower odds of remaining seizure-free during pregnancy compared with those with temporal lobe epilepsy TLE and OFEs. Non-adherence to antiseizure medications was significantly associated with increased seizure frequency (p < 0.0001). WWE had higher rates of cesarean section, preterm birth, and premature rupture of membranes compared with women without epilepsy. Neonates of WWE had higher rates of five-minute Apgar scores ≤7 and perinatal hypoxia (pH), with pH significantly associated with any in utero seizure exposure (OR 9.33; p = 0.04), independent of seizure form. Offspring of women with FLE had the highest prevalence of low Apgar scores compared with TLE and OFEs.

Conclusion: Seizure occurrence during pregnancy, rather than the specific form of FE alone, can be considered the primary factor contributing to adverse maternal and neonatal outcomes. These findings emphasize the importance of continuous seizure management, ASM adherence, and individualized perinatal care in WWE.

Keywords: Antiseizure medication; Focal epilepsy; Neonatal outcomes; Perinatal hypoxia; Pregnancy; Seizure control.