Epilepsy Management in Pregnancy and Reproductive Health
Summary
Effective management of epilepsy in women of childbearing age demands a careful balance between maintaining seizure control and minimising risks to the developing foetus. Preconception counselling is essential, with emphasis on achieving optimal seizure stability on the lowest effective dose of antiepileptic drugs (AEDs) and supplementing with folic acid to reduce neural tube defect risk. During pregnancy, physiological changes affect drug metabolism, necessitating regular clinical assessment and, where appropriate, serum drug monitoring to adjust dosages and avert breakthrough seizures. Interdisciplinary collaboration among neurologists, obstetricians, midwives and primary‐care providers underpins individualised care pathways, from planning conception to the postnatal period. Risk stratification tools and decision‐support systems are increasingly used to guide therapeutic choices, minimise teratogenic exposure and anticipate maternal or neonatal complications. In labour, choice of analgesia and mode of delivery should reflect the woman’s seizure history and obstetric indications. Postpartum follow-up ensures timely dose adjustments as pharmacokinetics normalise and supports maternal mental health and breastfeeding decisions. Overall, contemporary practice aims to secure both maternal neurological stability and healthy reproductive outcomes through personalised, evidence-informed strategies.
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Epilepsy Management in Pregnancy and Reproductive Health publication trend
The graph below shows the total number of articles in epilepsy management in pregnancy and reproductive health across all publications each year (not limited to Nature Index journals).
Technical terms
Antiepileptic drugs (AEDs): Medications prescribed to prevent or reduce the frequency and severity of epileptic seizures by modulating neuronal excitability.
Teratogenicity: The capacity of an agent to cause congenital malformations or developmental abnormalities in the embryo or foetus.
Serum drug monitoring: Measurement of drug concentrations in the blood to inform dose adjustments and ensure therapeutic efficacy while minimising toxicity.
Prognostic model: A statistical tool that uses patient characteristics and clinical variables to estimate the probability of a future clinical event, such as seizure recurrence, in an individual.
References
- Whole-cycle management of women with epilepsy of child-bearing age: ontology construction and application. BMC Medical Informatics and Decision Making (2024).
- Epilepsy in Pregnancy—Management Principles and Focus on Valproate. International Journal of Molecular Sciences (2022).
- Predicting seizures in pregnant women with epilepsy: Development and external validation of a prognostic model. PLOS Medicine (2019).
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