Prescribing patterns of antiseizure medications among pregnant women in Oman: a cross-sectional study

Background: Epilepsy during pregnancy poses significant clinical challenges, with maternal and fetal outcomes po¬tentially influenced by both the disease itself and the use of antiseizure medications (ASMs). In recent years, pre¬scribing trends have shifted toward newer, comparatively safer ASMs. Aim: This study analyzed ASM use, epilepsy control, and medication adjustments among pregnant women with epilepsy (PWWE). Methodology: A retrospective cross-sectional study reviewed medical records of 102 PWWE. Data on epilepsy classification, ASM prescriptions, medication adjustments, and therapeutic drug monitoring (TDM) were collected and analyzed. Results: Unspecified epilepsy was most common (43%), followed by focal (36%) and generalized (21%) epilepsy. Seizure control was achieved in 63.6% of cases, with levetiracetam (LEV) (33%) being the most prescribed ASM. ASM modifications occurred in 28% of cases, primarily in the first (11.6%) and third (10.3%) trimesters. LEV prescriptions increased during pregnancy, while carbamazepine (CBZ) and valproate (VPA) use declined. Only 5% of patients underwent TDM. Conclusion: Most PWWE maintained stable ASM regimens, but a significant proportion experienced medication adjustments. TDM utilization was low despite guideline recommendations. Improved monitoring and individualized ASM management are essential for optimizing maternal and fetal outcomes.