Women's Health World Conference 2026

Abstract

Pregnancy is the most unstable state for a woman with epilepsy and the most dangerous one in terms of terminating even a stable and long-term remission. The probability of recurrence of seizures during pregnancy reaches 29.5%, and in some cases pregnancy is a provoking factor in the onset of epilepsy. In addition, women with epilepsy have an increased risk of obstetric complications, for example, the risk of preeclampsia in women with epilepsy exceeds 2 times the general population, and gestosis develops in about 30% of pregnant women.
Seizures increase in 15-30% of pregnant women, especially in the first and third trimesters. Recovery from remission during pregnancy is explained by pharmacokinetic changes caused by pregnancy: increased intensity of metabolic processes and, as a result, a decrease in the concentration of anticonvulsants; increased volume of distribution due to an increase in the volume of circulating blood; higher renal elimination of anticonvulsants; altered activity of liver enzymes; decreased protein levels in blood plasma. In addition, changes in the hormonal background and immunological reactivity of the body are one of the factors contributing to the exacerbation of seizures.

The main risks for a child from a mother with epilepsy are associated with both the epileptic seizures themselves and the teratogenic effect of anticonvulsants. Pregnancy planning is extremely important for women with epilepsy. At the stage of pre-gravid preparation, it is extremely important to consolidate the stability of remission and eliminate all possible proeliptogenic factors in the body. Moreover, the management of systemic processes in the body is important in such a situation – that is, not the symptomatic effect of anticonvulsants, but the effect on the pathogenetic pathways of the development of convulsive syndrome which matters. This approach allows you to reduce the dosages of medications taken, which in its turn minimizes their harmful effects on the body of women and children, as well as in case of failure of remission during pregnancy, it allows you to increase the effective dosage of the drug in a safe range.

However, grafting the dosages of anticonvulsants increases the risk of teratogenic effects on the fetus, which requires the search for alternative ways to enhance antiepileptic protection. Hormonal changes are an important factor that can increase the frequency of epileptic seizures during pregnancy. For example, fluctuations in progesterone concentration can have a significant effect on the course of epilepsy. Progesterone and its derivatives act as receptor modulators for neurotransmitters, in particular, such as gamma-aminobutyric acid (GABA). Hormonal correction in case of recurrence of seizures may act as an alternative to increasing the dosage of anticonvulsants in pregnant women.

Careful monitoring of the patient's clinical condition, the dynamics of electroencephalography (EEG) parameters, and the concentration of anticonvulsants during pregnancy is required. The effective protocols for the safe preparation and management of pregnancy for women with epilepsy that allow them to safely carry and give birth, as well as minimize the risks to children have been developed by our team