Seizure control, delivery, and neonatal outcomes according to parity in women with epilepsy: A prospective cohort study

To evaluate seizure control and obstetric and neonatal outcomes according to parity in women with epilepsy (WWE).

In this prospective cohort study, 112 pregnant WWE were enrolled and their delivery and neonatal outcomes were compared with those of 285 women without epilepsy. Parity-specific associations with maternal and neonatal complications were systematically analyzed.

The proportion of multigravida pregnant WWE was significantly higher (51.8%) compared to those without epilepsy (38.9%) (odds ratio [OR] 1.68; 95% confidence interval [CI] 1.08-2.62; p = 0.02). Multigravida patients were less likely to plan subsequent pregnancies (60.0% vs. 88.9%; p = 0.04). Pregnancies in both primigravida and multigravida WWE were associated with higher cesarean section rates (p < 0.0001) compared to controls. Primigravida WWE were at increased risk of preterm delivery, whereas the multigravida WWE had higher odds of premature ruptures of membranes compared with those pregnancies in the control group (p = 0.0465 and p = 0.01, respectively). The rate of Apgar scores at 5 min ≤ 7 was higher in neonates born to primigravida and multigravida mothers with epilepsy compared to infants born to primigravida and multigravida women in the control group (p = 0.0002 and p = 0.0005, respectively).

Parity was not significantly associated with adverse obstetric or neonatal outcomes among WWE. Nonetheless, epilepsy itself remained a key contributor to delivery and neonatal complications. These findings emphasize the importance of early preconception counseling and effective seizure management to optimize maternal and neonatal outcomes in both first and subsequent pregnancies.