Abstract
Objective
To identify risk factors for seizure in pregnant women, and in the general population with
epilepsy.
Study Design
Umbrella review of clinical practice guidelines and systematic reviews on risk factors or
prediction models for seizure occurrence in pregnant women with epilepsy, adults with
epilepsy, or all individuals with epilepsy. Guidelines or systematic reviews exclusively for
children were excluded. We searched MEDLINE, Emcare, Embase, CINAHL, TRIP PRO,
Epistemonikos, World Health Organisation, Guideline International Network, DANS, and grey
literature (2000-2023) without language restrictions. Risk factors or predictors listed in the final
guidelines or systematic reviews were collated and thematically analysed.
Results
From 3406 citations, we included 13 articles (ten guidelines, three systematic reviews)
reporting 26 risk factors in pregnant women and the general adult population with epilepsy:
eight in guidelines for pregnant women only; five in both pregnant women and general adult
populations (four in both guidelines and systematic reviews, one in guidelines only); and 13
factors in the general adult population (four in both guidelines and systematic reviews, eight in
guidelines, and one in a systematic review). Risk factors were categorised into five broad
themes seizure type; seizure control; anti-seizure medication; neurological; and epilepsy and
medical history. Three risk factors for seizure ocurrence were cited in more than two guidelines
or systematic reviews: seizure freedom (reduced risk), immediate initiation of anti-seizure
medication after first seizure (reduced risk), and abnormal electroencephalogram (increased
risk). Three risk factors were linked to a more than two-fold chance of seizures in pregnant
women with epilepsy: tonic-clonic seizures in the last three months (RR 7.20, 95% CI 6.63-
11.93), a history of non-tonic-clonic seizures (RR 2.11, 95% CI 1.88—2.62), and seizures in the
pre-pregnancy year compared to no seizures (RR 3.51, 95% CI 3.13-3.94).
Conclusion
Multiple risk factors have been recommended for use in practice across different guidelines and
reviews to identify those at increased risk of seizure risk in adult population with epilepsy, and
specifically in pregnant women with epilepsy. Further research is needed on the
implementation of tools for predicting seizures to improve maternal and neonatal outcomes
To identify risk factors for seizure in pregnant women, and in the general population with
epilepsy.
Study Design
Umbrella review of clinical practice guidelines and systematic reviews on risk factors or
prediction models for seizure occurrence in pregnant women with epilepsy, adults with
epilepsy, or all individuals with epilepsy. Guidelines or systematic reviews exclusively for
children were excluded. We searched MEDLINE, Emcare, Embase, CINAHL, TRIP PRO,
Epistemonikos, World Health Organisation, Guideline International Network, DANS, and grey
literature (2000-2023) without language restrictions. Risk factors or predictors listed in the final
guidelines or systematic reviews were collated and thematically analysed.
Results
From 3406 citations, we included 13 articles (ten guidelines, three systematic reviews)
reporting 26 risk factors in pregnant women and the general adult population with epilepsy:
eight in guidelines for pregnant women only; five in both pregnant women and general adult
populations (four in both guidelines and systematic reviews, one in guidelines only); and 13
factors in the general adult population (four in both guidelines and systematic reviews, eight in
guidelines, and one in a systematic review). Risk factors were categorised into five broad
themes seizure type; seizure control; anti-seizure medication; neurological; and epilepsy and
medical history. Three risk factors for seizure ocurrence were cited in more than two guidelines
or systematic reviews: seizure freedom (reduced risk), immediate initiation of anti-seizure
medication after first seizure (reduced risk), and abnormal electroencephalogram (increased
risk). Three risk factors were linked to a more than two-fold chance of seizures in pregnant
women with epilepsy: tonic-clonic seizures in the last three months (RR 7.20, 95% CI 6.63-
11.93), a history of non-tonic-clonic seizures (RR 2.11, 95% CI 1.88—2.62), and seizures in the
pre-pregnancy year compared to no seizures (RR 3.51, 95% CI 3.13-3.94).
Conclusion
Multiple risk factors have been recommended for use in practice across different guidelines and
reviews to identify those at increased risk of seizure risk in adult population with epilepsy, and
specifically in pregnant women with epilepsy. Further research is needed on the
implementation of tools for predicting seizures to improve maternal and neonatal outcomes
| Original language | English |
|---|---|
| Pages (from-to) | 241-250 |
| Journal | European Journal of Obstetrics and Gynecology and Reproductive Biology |
| Volume | 308 |
| DOIs | |
| Publication status | Published (VoR) - 10 Mar 2025 |