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

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