Factors predicting seizure control and delivery outcomes in women with epilepsy with planned and unplanned pregnancy.

Objective: To determine and ascertain factors influencing seizure control and maternal and neonatal outcomes in women with epilepsy (WWE) with planned versus unplanned pregnancies.

Methods: One hundred twelve pregnant WWE were prospectively evaluated for over an eight-year period. Patients were subsequently evaluated at 3, 6, and 12 months after delivery and then were followed up by a neurologist at least three years after delivery.

Results: The proportion of the patients with increased seizure frequency was higher in focal epilepsy versus generalized epilepsy (P<0.05). The occurrence of seizures during pregnancy was associated with poor seizure control one year prior to the pregnancy and nonadherence to treatment (P<0.0001). Structural brain abnormalities were associated with a higher risk of seizures during pregnancy (P=0.03). Women with seizures during pregnancy (P=0.0069) and with non-adherence to antiseizure medication (ASM) treatment had a higher rate of cesarean section (P=0.0069 and P<0.05, respectively). The rates of adverse delivery outcomes were not higher in women with planned pregnancies compared to women with unplanned pregnancies. However, offspring of mothers with unplanned pregnancies and nonadherence to treatment were at higher risk of an Apgar score at 5minutes≤7 compared with infants of planned pregnancies (P=0.02 and P=0.0001, respectively).

Conclusion: Seizure control prior to pregnancy, epilepsy type, adherence to ASM therapy, and pregnancy planning are potential factors influencing both seizure control and delivery outcomes in WWE. Our findings imply that systematic preconception counseling is crucial to preventing seizure deterioration in pregnancy and reducing the maternal and fetal complications.