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

Oladipupo Olalere; Saba Tariq; Olanike Ajijola; Min-Dee Koh; Katie Crabb; Amie Wilson; Anwesa Chatterjee; Mairead Black; Katie Morris; Matthew Bluett-Duncan; Emily Taylor; Sereena Raju; Fatima Junaid; Rebecca Bromley; Ngawai Moss; Marta Garcia-Finana; John Craig; Amanda Wood; Annalise Weckesser; Judith Dyson; Catherine Nelson-Piercy; Elaine Denny; Tracy Roberts; Rachel McNeill; Shakila Thangaratinam; John Allotey

doi:10.1371/journal.pmed.1004580

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

Oladipupo Olalere
, Saba Tariq
, Olanike Ajijola
, Min-Dee Koh
, Katie Crabb
, Amie Wilson
, Anwesa Chatterjee
, Mairead Black
, Katie Morris
, Matthew Bluett-Duncan
, Emily Taylor
, Sereena Raju
, Fatima Junaid
, Rebecca Bromley
, Ngawai Moss
, Marta Garcia-Finana
, John Craig
, Amanda Wood
, Annalise Weckesser
, Judith Dyson

Catherine Nelson-Piercy, Elaine Denny, Tracy Roberts, Rachel McNeill, Shakila Thangaratinam, John Allotey

Research output: Contribution to journal › Article › peer-review

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 fetal 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 (OR) with 95% confidence intervals (CI).
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 fetal outcomes. Risk assessment to identify women with epilepsy at highest risk of seizures is needed to optimise care.

Original language	English
Article number	e1004580
Journal	PLoS Medicine
Volume	22
Issue number	10
DOIs	https://doi.org/10.1371/journal.pmed.1004580
Publication status	Published (VoR) - 31 Oct 2025

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Olalere, O., Tariq, S., Ajijola, O., Koh, M.-D., Crabb, K., Wilson, A., Chatterjee, A., Black, M., Morris, K., Bluett-Duncan, M., Taylor, E., Raju, S., Junaid, F., Bromley, R., Moss, N., Garcia-Finana, M., Craig, J., Wood, A., Weckesser, A., ... Allotey, J. (2025). Associations between epileptic seizures in pregnancy and adverse pregnancy outcomes: A systematic review and meta-analysis. PLoS Medicine, 22(10), Article e1004580. https://doi.org/10.1371/journal.pmed.1004580

@article{9294d688af6d4ea5af0dba0f14202306,

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

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 fetal 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 (OR) with 95\% confidence intervals (CI). 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 fetal outcomes. Risk assessment to identify women with epilepsy at highest risk of seizures is needed to optimise care. ",

author = "Oladipupo Olalere and Saba Tariq and Olanike Ajijola and Min-Dee Koh and Katie Crabb and Amie Wilson and Anwesa Chatterjee and Mairead Black and Katie Morris and Matthew Bluett-Duncan and Emily Taylor and Sereena Raju and Fatima Junaid and Rebecca Bromley and Ngawai Moss and Marta Garcia-Finana and John Craig and Amanda Wood and Annalise Weckesser and Judith Dyson and Catherine Nelson-Piercy and Elaine Denny and Tracy Roberts and Rachel McNeill and Shakila Thangaratinam and John Allotey",

year = "2025",

month = oct,

day = "31",

doi = "10.1371/journal.pmed.1004580",

language = "English",

volume = "22",

journal = "PLoS Medicine",

issn = "1549-1277",

publisher = "Public Library of Science",

number = "10",

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Olalere, O, Tariq, S, Ajijola, O, Koh, M-D, Crabb, K, Wilson, A, Chatterjee, A, Black, M, Morris, K, Bluett-Duncan, M, Taylor, E, Raju, S, Junaid, F, Bromley, R, Moss, N, Garcia-Finana, M, Craig, J, Wood, A, Weckesser, A , Dyson, J, Nelson-Piercy, C, Denny, E, Roberts, T, McNeill, R, Thangaratinam, S & Allotey, J 2025, 'Associations between epileptic seizures in pregnancy and adverse pregnancy outcomes: A systematic review and meta-analysis', PLoS Medicine, vol. 22, no. 10, e1004580. https://doi.org/10.1371/journal.pmed.1004580

TY - JOUR

T1 - Associations between epileptic seizures in pregnancy and adverse pregnancy outcomes: A systematic review and meta-analysis

AU - Olalere, Oladipupo

AU - Tariq, Saba

AU - Ajijola, Olanike

AU - Koh, Min-Dee

AU - Crabb, Katie

AU - Wilson, Amie

AU - Chatterjee, Anwesa

AU - Black, Mairead

AU - Morris, Katie

AU - Bluett-Duncan, Matthew

AU - Taylor, Emily

AU - Raju, Sereena

AU - Junaid, Fatima

AU - Bromley, Rebecca

AU - Moss, Ngawai

AU - Garcia-Finana, Marta

AU - Craig, John

AU - Wood, Amanda

AU - Weckesser, Annalise

AU - Dyson, Judith

AU - Nelson-Piercy, Catherine

AU - Denny, Elaine

AU - Roberts, Tracy

AU - McNeill, Rachel

AU - Thangaratinam, Shakila

AU - Allotey, John

PY - 2025/10/31

Y1 - 2025/10/31

N2 - 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 fetal 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 (OR) with 95% confidence intervals (CI). 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 fetal outcomes. Risk assessment to identify women with epilepsy at highest risk of seizures is needed to optimise care.

AB - 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 fetal 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 (OR) with 95% confidence intervals (CI). 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 fetal outcomes. Risk assessment to identify women with epilepsy at highest risk of seizures is needed to optimise care.

UR - https://www.open-access.bcu.ac.uk/16711/

U2 - 10.1371/journal.pmed.1004580

DO - 10.1371/journal.pmed.1004580

M3 - Article

SN - 1549-1277

VL - 22

JO - PLoS Medicine

JF - PLoS Medicine

IS - 10

M1 - e1004580

ER -

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

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