Epilepsy Drugs in Pregnancy Linked to Perinatal Risks

Study Reveals Antiseizure Medications, Not Epilepsy Itself, as Primary Culprit

A recent study highlights the increased odds of adverse perinatal outcomes linked to maternal epilepsy. However, the research pinpoints prenatal exposure to antiseizure medications (ASMs) as the main driver of these challenges, offering crucial insights for expectant mothers and healthcare professionals.

Study Methodology Unveiled

Researchers undertook a retrospective population-based cohort study. They examined national health data from Scotland spanning from 2009 to 2021. The study encompassed a total of 629,200 pregnancies. Of those, 2022 involved women with epilepsy, while the remaining 627,178 pregnancies were in women without the condition.

Maternal epilepsy was identified via International Classification of Diseases, Tenth Revision codes. These codes were pulled from pregnancy records or hospital admissions within two years before the estimated conception through the pregnancy. The analysis focused on exposure to ASMs.

Exposure to ASMs was defined as any medication dispensed 30 days before the estimated conception until the pregnancy’s end. The study’s primary aim was to assess the connection between maternal epilepsy and adverse perinatal outcomes. Additional focus was given to effect estimates for exposure to specific ASM monotherapies.

Key Findings and Outcomes

Compared to women without epilepsy, those with the condition displayed increased odds of induced labor (aOR, 1.17; 95% CI, 1.02-1.34) even after adjustments for exposure to ASMs. Prenatal exposure to ASMs was linked with greater odds of preterm birth (aOR, 1.47; 95% CI, 1.25-1.74), induced labor (aOR, 1.38; 95% CI, 1.25-1.52), and NICU admission (aOR, 1.54; 95% CI, 1.33-1.78).

Valproate monotherapy showed the strongest link with congenital conditions (aOR, 3.91; 95% CI, 2.36-6.49), with carbamazepine monotherapy following closely behind (aOR, 1.90; 95% CI, 1.16-3.10).

“Maternal epilepsy is associated with many adverse perinatal outcomes, but most are driven by prenatal ASM exposure. We postulate that joint comprehensive care between obstetricians and epileptologists or other specialists who prescribe ASMs could improve perinatal outcomes,”

—The Study Authors

A 2023 report by the Centers for Disease Control and Prevention indicates that about 3.4 million women aged 15–44 years in the United States reported having epilepsy or seizures. (CDC)

In-Depth Analysis and Implications

The study, led by Paolo Pieirino Mazzone of the Muir Maxwell Epilepsy Centre, University of Edinburgh, emphasizes the critical role of ASMs. This highlights the need for a combined approach in the management of pregnant women with epilepsy.

The study was published online on June 16, 2025, in Epilepsia.

Limitations and Disclosures

The study’s limitations include an inability to consider epilepsy specifics. These include the aetiology, type/syndrome, or seizure frequency/severity. It also did not cover the duration or trimester of ASM dispensation. The reasons for ASM use apart from epilepsy weren’t investigated.

The study did not receive external funding. One author reported receiving consultant, lecture, and/or conference-attendance fees. Another author reported external funding support unrelated to the study.

This study underscores the importance of carefully evaluating ASM use during pregnancy. The findings underscore the need for collaborative care between obstetricians and neurologists to safeguard both the mother and child’s health.