# Evaluation of the management of high-risk obstetric patients living with epilepsy: A retrospective study from KwaZulu-Natal, South Africa

## TL;DR

This study examines how high-risk pregnant women with epilepsy are managed in South Africa, finding gaps in drug selection and monitoring that could affect maternal and fetal health.

## Contribution

The study provides novel, context-specific evidence on epilepsy management during pregnancy in a South African setting.

## Key findings

- Sodium valproate was prescribed to 60% of patients, often in combination with other drugs.
- Therapeutic drug monitoring was performed in less than 60% of patients.
- Poor seizure control was strongly linked to frequent hospital admissions.

## Abstract

Epilepsy affects approximately 60 million individuals worldwide, with women comprising nearly 50% of the cases. Physiological changes during pregnancy can alter anti-epileptic drug (AED) pharmacokinetics and seizure thresholds, necessitating close therapeutic drug monitoring (TDM). Uncontrolled maternal seizures increase the risk of maternal morbidity, foetal hypoxia and miscarriage. Several AEDs have a known teratogenic potential, highlighting the importance of adherence to clinical guidelines to optimise maternal and foetal outcomes.

A retrospective quantitative study was conducted at a high-risk obstetrics clinic in a public tertiary hospital in KwaZulu-Natal, South Africa, using clinical records from a 5-year period. Of 131 cases, N = 90 met the inclusion criteria. Data were extracted into Microsoft Excel® and analysed using SPSS® (v29). Descriptive and inferential analyses (chi-square, Fisher’s exact, Spearman’s correlation, Mann–Whitney U and logistic regression) were used to assess the associations between variables.

Sodium valproate was prescribed to 60% of patients in the cohort. Folic acid supplementation was documented in 70% of cases (n = 63). Sodium valproate use was significantly associated with polytherapy (p = 0.007). Therapeutic drug monitoring was performed in 56.7% of patients and prenatal ultrasounds in 67.8%. A strong correlation was observed between the total admission frequency and seizure-related admissions (Spearman’s ρ = 0.74, p < 0.001).

The study identified gaps in care, including suboptimal AED selection, limited TDM, inconsistent ultrasound use, frequent polytherapy and increased admissions from poor seizure control. Addressing these may improve the safety and effectiveness of epilepsy management in pregnancy.

This study contributes novel, context-specific evidence on real-world epilepsy management during pregnancy. It identifies critical gaps in clinical practice, AED selection and therapeutic monitoring.