Nearly Half of Women with Epilepsy Miss Out on Specialist Care During Pregnancy, Study Finds
Key Takeaways:
Pregnant women with epilepsy and their babies are at risk of harm from seizures and antiseizure medications (ASMs)
Neurologists can provide expert guidance during pregnancy to reduce risk, yet 45% of women with epilepsy don’t see a neurologist in the year before giving birth
Women who saw a neurologist in the year before giving birth were much more likely to take a recommended ASM, and less likely to stop ASM treatment
Newswise — BALTIMORE, Sept. 15, 2025 – Only slightly more than half of women with epilepsy see a neurologist during pregnancy, a gap that could put both mother and baby at increased risk, according to new research presented at the 150th Annual Meeting of the American Neurological Association (ANA).
While guidelines recommend a range of strategies to reduce pregnancy-related risks for women with epilepsy and their babies—such as fine-tuning antiseizure medications (ASM) and closely monitoring drug levels—the study found that 45% of women didn’t see a neurologist at all in the year leading up to delivery. That may mean missed opportunities to prevent complications such as seizures, birth defects or poor neurodevelopmental outcomes. Women who saw a neurologist were far more likely to take recommended ASMs —and less likely to stop ASM treatment altogether—compared to those who didn’t receive care from a neurologist.
“This study of recent national data shows how many women with epilepsy may not be accessing the specialist care they need during pregnancy,” said lead author Chloe Hill, MD, MS, assistant professor of neurology at the University of Michigan, Ann Arbor. “While there is no specific recommendation that women see a neurologist before or during pregnancy, these experts play a key role in implementing risk-reduction strategies that improve outcomes for women and their babies.”
For example, neurologists can ensure that women are taking folic acid supplements and the best ASM at the right dose, as some ASMs can increase the risk of birth defects, including spina bifida, cleft lip or palate, heart defects and lower IQ. However, uncontrolled seizures are also dangerous for the mother and baby, raising the risk of placental abruption, reduced oxygen supply, maternal mortality, growth restriction, preterm birth and miscarriage or stillbirth. Neurologists have the expertise to carefully balance seizure control with reduced medication-related risks. In some cases, that may mean prescribing more than one ASM, or a riskier ASM if it is the only one that controls a woman’s seizures.
Drawing from a large national commercial health claims database, the researchers identified 2,385 women with epilepsy who delivered babies between 2016 and 2021. In the year before delivery, 1,322 (55%) saw a neurologist. Researchers determined 59% of the women overall were taking one ASM, 17% were on two ASMs, 5% were on three or more ASMs, and 19% were not taking any ASM in the year prior to delivery.
Overall, 62% were taking an ASM that is recommended for pregnancy (e.g. levetiracetam, lamotrigine or oxcarbazepine), while 13.3% were taking an ASM that is not recommended (valproic acid, topiramate or phenobarbital). Further, women who saw a neurologist were more likely to be on a recommended ASM (74% who saw a neurologist vs. 48% who did not) and were less likely to stop taking their ASM in the year before delivery (8% who saw a neurologist vs. 33% who did not).
The gap highlights a systemic issue in how care is coordinated during pregnancy.
“Pregnant women with epilepsy and their infants have a higher risk of poor outcomes compared to the general population,” said Dr. Hill. “Seeing a neurologist during pregnancy is one important means to promote clinical practice guideline-concordant care for pregnant women with epilepsy, which supports safer pregnancies and healthier outcomes for women with epilepsy and their babies.”