Pregnancy and primary epilepsy: the interwoven effects on seizure dynamics, AED management, and fetal well-being”

Abstract Background Pregnancy can significantly influence seizure control and antiepileptic drug (AED) pharmacokinetics in women with epilepsy. This case–control study evaluated the impact of pregnancy on seizure frequency, AED serum levels, treatment adherence, and maternal–fetal outcomes in women with primary epilepsy. Methods Sixty women with primary epilepsy (30 pregnant and 30 non-pregnant) were prospectively assessed. Collected data included sociodemographic characteristics, seizure patterns, AED regimens, serum AED levels, EEG findings, and perinatal outcomes. Seizure frequency changes were monitored across pregnancy in the case group and compared with the control group. Results Increased seizure frequency was observed in 47% of pregnant women compared with 16.7% of controls. Pregnant women demonstrated significantly higher rates of sub-therapeutic serum levels of sodium valproate (59.1% vs. 15.8%; P = 0.005) and carbamazepine (26.7% vs. 0%; P = 0.032), while phenytoin levels showed no significant difference between groups. EEG abnormalities were detected in four cases and four controls; polyspike discharges appeared only in controls. Non-compliance with AED therapy was more frequent among pregnant women and was strongly associated with seizure exacerbation. A history of catamenial epilepsy was associated with higher, though non-significant, rates of increased seizure frequency (44.4% vs. 16.7%; P = 0.068) and worsening seizure severity (50.0% vs. 16.7%; P = 0.060). Adverse perinatal outcomes included preterm delivery (20.0%), low birth weight (16.7%), and congenital anomalies (6.7%). Conclusions Pregnancy is associated with an increased risk of seizure exacerbation in women with primary epilepsy, primarily due to sub-therapeutic AED levels and reduced treatment adherence. Routine therapeutic drug monitoring and targeted counseling are essential to maintaining seizure control and minimizing maternal–fetal complications. Improved access to safer, cost-effective AEDs remains a priority in resource-limited settings.