First-trimester trace-element profiles in pregnant women with epilepsy: An exploratory prospective association between selenium and subsequent seizure recurrence

This study compares first-trimester serum zinc, copper, selenium and zinc-to-copper ratios between pregnant women with pre-existing epilepsy and healthy controls and assesses associations with subsequent seizure recurrence.

This prospective controlled study included 48 pregnant women with pre-existing epilepsy and 59 controls. All women with epilepsy had been seizure free for at least 2 years before conception. Trace elements were measured at 6-12 gestational weeks, before recurrence. Between-group differences were assessed using multivariable linear regression adjusted for maternal age, body mass index, smoking, and gestational week at sampling. Seizure recurrence was evaluated using logistic regression adjusted for epilepsy duration and type.

Compared with controls, women with epilepsy had 9.1% higher zinc, 56.3% higher copper, 16.8% lower selenium, and a 30.2% lower zinc-to-copper ratio after adjustment; all remained significant after false discovery rate correction. During follow-up, 20/48 women (41.7%) experienced recurrence. Selenium was lower in women with recurrence than in those who remained seizure free (36.53 [34.70-41.41] vs 46.36 [42.77-47.83] μg/L; P < 0.001), and each one-standard deviation increase in selenium was associated with lower odds of subsequent seizure recurrence after adjustment for epilepsy duration and type (adjusted OR 0.11, 95% CI 0.03-0.37). Zinc, copper, and the zinc-to-copper ratio were not associated with recurrence.

Pregnant women with epilepsy showed a distinct first-trimester trace-element profile. Lower first-trimester selenium was prospectively associated with subsequent seizure recurrence; however, this exploratory finding requires external validation before any predictive or clinical interpretation.