Epilepsy and Pregnancy: Neurological Outcomes of the Mother and Fetus in the Era of Personalized Therapy

Abstract

Epilepsy is one of the most common chronic neurological disorders affecting women of reproductive age, posing significant challenges during pregnancy due to potential risks for both the mother and the fetus. The management of epilepsy in pregnancy requires a careful balance between optimal seizure control and minimization of teratogenic and neurodevelopmental risks associated with antiseizure medications. In recent years, advances in personalized therapy have transformed clinical approaches, allowing for more individualized risk assessment and treatment strategies. This study aims to review current evidence on neurological outcomes in pregnant women with epilepsy and their offspring in the context of personalized medicine. A comprehensive analysis of recent literature was conducted, focusing on seizure control, pharmacotherapy optimization, teratogenicity, and long-term neurodevelopmental outcomes in children. The findings indicate that well-controlled epilepsy is associated with favorable maternal and fetal outcomes, whereas uncontrolled seizures, particularly generalized tonic–clonic seizures, significantly increase the risk of maternal complications, fetal hypoxia, preterm birth, and neurodevelopmental impairment. The choice and dosage of antiseizure medications play a critical role, with newer-generation drugs demonstrating improved safety profiles compared to older agents such as valproate, which remains associated with a high risk of congenital malformations and cognitive impairment. Personalized therapy, including therapeutic drug monitoring, dose adjustments during pregnancy, and individualized drug selection has been shown to reduce adverse outcomes while maintaining effective seizure control.