Associations between epileptic seizures in pregnancy and adverse pregnancy outcomes: A systematic review and meta-analysis

Olalere, Oladipupo and Tariq, Saba and Ajijola, Olanike and Koh, Min-Dee and Crabb, Katie and Wilson, Amie and Chatterjee, Anwesa and Black, Mairead and Morris, Katie and Bluett-Duncan, Matthew and Taylor, Emily and Raju, Sereena and Junaid, Fatima and Bromley, Rebecca and Moss, Ngawai and Garcia-Finana, Marta and Craig, John and Wood, Amanda and Weckesser, Annalise and Dyson, Judith and Nelson-Piercy, Catherine and Denny, Elaine and Roberts, Tracy and McNeill, Rachel and Thangaratinam, Shakila and Allotey, John (2025) Associations between epileptic seizures in pregnancy and adverse pregnancy outcomes: A systematic review and meta-analysis. PLOS Medicine, 22 (10). e1004580. ISSN 1549-1676

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Abstract

Background

Epileptic seizures during pregnancy may increase the risk of adverse pregnancy outcomes. Socioeconomic disparities in epilepsy incidence may extend to seizure control. We conducted a systematic review and meta-analysis to assess the association between epileptic seizures during pregnancy and adverse pregnancy outcomes. We also evaluated the association between socioeconomic and individual-level factors and seizure occurrence.

Methods and findings

We searched MEDLINE, Embase, CINAHL, and PsycINFO databases from inception to May 2025 for observational studies on pregnant women with epileptic seizures. We compared maternal and foetal outcomes in pregnant women with and without seizures and assessed the association between seizure occurrence and socioeconomic or individual-level factors. We used the Newcastle–Ottawa Scale to assess the risk of bias of included studies. Meta-analyses using random effects model were performed to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs).

From 13,381 identified publications, 25 studies (24,596 pregnancies) are included in this analysis. In pregnant women with epilepsy, women with seizures compared to those without had increased odds of caesarean birth (OR 1.62, 95% CI 1.14 to 2.30, p = 0.007), peripartum depression (OR 2.20, 95% CI 1.04 to 4.65, p = 0.04), and small for gestational age baby (OR 1.32, 95% CI 1.03 to 1.69, p = 0.03). The odds of preterm birth (OR 1.66, 95% CI 1.29 to 2.15, p < 0.001), low birthweight (OR 1.47, 95% CI 1.12 to 1.93, p = 0.006), and small for gestational age baby (OR 1.44, 95% CI 1.19 to 1.74, p < 0.001) were higher in women with seizures compared to women without epilepsy. The risk of seizures was greater in pregnant women with epilepsy with low income compared to those with higher income (OR 1.57, 95% CI 1.22 to 2.02, p < 0.001), and in women with focal epilepsy compared to those with generalised epilepsy (OR 1.84, 95% CI 1.54 to 2.20, p < 0.001). The number of studies for some outcomes was small, limiting subgroup analyses and detection of heterogeneity.

Conclusion

Epileptic seizures are associated with increased risks of adverse maternal and foetal outcomes. Risk assessment to identify women with epilepsy at highest risk of seizures is needed to optimise care.

Item Type:	Article
Identification Number:	10.1371/journal.pmed.1004580
Dates:	Date Event 10 October 2025 Accepted 31 October 2025 Published Online
Subjects:	CAH02 - subjects allied to medicine > CAH02-04 - nursing and midwifery > CAH02-04-01 - nursing (non-specific)
Divisions:	Nursing and Midwifery > Adult Nursing
Depositing User:	Gemma Tonks
Date Deposited:	10 Nov 2025 13:25
Last Modified:	10 Nov 2025 13:25
URI:	https://www.open-access.bcu.ac.uk/id/eprint/16711

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