{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T02:00:41Z","timestamp":1772244041681,"version":"3.50.1"},"update-to":[{"DOI":"10.3310\/nihropenres.13743.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T00:00:00Z","timestamp":1739318400000}}],"reference-count":27,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T00:00:00Z","timestamp":1739318400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["NIHR Clinical Lectureship"],"award-info":[{"award-number":["NIHR Clinical Lectureship"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Department of Health","award":["Policy Research Programme (reference 108\/0001)"],"award-info":[{"award-number":["Policy Research Programme (reference 108\/0001)"]}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["NIHR Senior Investigator; award reference NIHR303806"],"award-info":[{"award-number":["NIHR Senior Investigator; award reference NIHR303806"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["NIHR Professorship NIHR-RP-011-032"],"award-info":[{"award-number":["NIHR Professorship NIHR-RP-011-032"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["openresearch.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["NIHR Open Res"],"abstract":"<ns3:p>\n                    Background Epilepsy affects one percent of the UK population and is the most common serious neurological condition experienced during pregnancy. We compared the characteristics, clinical management, and pregnancy outcomes in women with severe, uncontrolled epilepsy to those of women with well controlled disease. Methods We conducted a population-based case-control study in all UK consultant-led maternity units. Cases of severe uncontrolled epilepsy during pregnancy were identified prospectively and reported via the UK Obstetric Surveillance System (UKOSS). Severe epilepsy was defined\n                    <ns3:italic>a-priori<\/ns3:italic>\n                    as \u22651 of the following: admission to hospital during pregnancy to manage seizures; prescribed \u22653 antiepileptic medications; or died from epilepsy. Controls comprised women with epilepsy not meeting the case definition, identified within the same centres as cases. Pre-pregnancy epilepsy control and pregnancy outcomes were compared between groups using multivariable logistic regression. Results We identified 94 cases between 1 October 2015 and 31 March 2017 and compared these with 186 controls. Cases were significantly more likely to be admitted to manage seizures in the year preceding pregnancy (42\/94 cases vs 10\/186 controls, adjusted odds ratio [aOR]=7.38 [95% CI 2.70-20.2]), and to report their most recent seizure within 3 months of pregnancy (51\/94 cases vs 18\/186 controls, aOR=5.86 [95% CI 2.30-15.0]). Cases were significantly more likely to deliver before 37 weeks (20\/94 cases vs 8\/186 controls, aOR=7.61 [95% CI 2.87-20.2]). Conclusions Women admitted for seizure management in the year before pregnancy are at higher risk of severe epilepsy during pregnancy and of preterm birth. These women should be prioritised for discussion about pregnancy and contraception. When pregnant, they should be reviewed as early as possible by specialists in the management of epilepsy during pregnancy. Delivering messages about the importance of pregnancy planning and contraception to all women with epilepsy should be viewed as the responsibility of all clinicians involved their care.\n                  <\/ns3:p>","DOI":"10.3310\/nihropenres.13743.2","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T11:40:06Z","timestamp":1739360406000},"page":"53","update-policy":"https:\/\/doi.org\/10.3310\/nihropenres.crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Severe, uncontrolled epilepsy in pregnancy: A population-based case-control study"],"prefix":"10.3310","volume":"4","author":[{"given":"Bryn","family":"Kemp","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Kelso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8186-9124","authenticated-orcid":false,"given":"David","family":"Williams","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1984-4575","authenticated-orcid":false,"given":"Marian","family":"Knight","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"6221","published-online":{"date-parts":[[2025,2,12]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"37-42","DOI":"10.1016\/j.seizure.2023.01.003","article-title":"The incidence and prevalence of epilepsy in the United Kingdom 2013-2018: a retrospective cohort study of UK primary care data.","volume":"105","author":"S Wigglesworth","year":"2023","journal-title":"Seizure."},{"key":"ref-2","article-title":"Saving lives, improving mothers\u2019 care core report - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2019-21.","author":"M Knight","year":"2023"},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"1575-83","DOI":"10.1136\/jnnp.2003.029132","article-title":"The longer term outcome of children born to mothers with epilepsy.","volume":"75","author":"N Adab","year":"2004","journal-title":"J Neurol Neurosurg Psychiatry."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"e1716-e1720","DOI":"10.1212\/WNL.0000000000006426","article-title":"Maternal death in women with epilepsy: smaller scope studies.","volume":"91","author":"J Christensen","year":"2018","journal-title":"Neurology."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"35-8","DOI":"10.1016\/j.seizure.2015.02.020","article-title":"The impact of seizures on pregnancy and delivery.","volume":"28","author":"L Sveberg","year":"2015","journal-title":"Seizure."},{"key":"ref-6","article-title":"Saving lives, improving mothers\u2019 care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries Into Maternal Deaths and Morbidity 2013-15.","author":"M Knight","year":"2017"},{"key":"ref-7","article-title":"Saving lives, improving mothers\u2019 care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2016-18.","author":"M Knight","year":"2020"},{"key":"ref-8","article-title":"Saving lives, improving mother\u2019s care.","author":"M Knight","year":"2014"},{"key":"ref-9","article-title":"Saving lives, improving mothers\u2019 care-Surveillance of maternal deaths in the UK 2012\u201314 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009\u201314.","author":"M Knight","year":"2017"},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"e72-4","DOI":"10.1111\/epi.12621","article-title":"SUDEP and epilepsy-related mortality in pregnancy.","volume":"55","author":"S Edey","year":"2014","journal-title":"Epilepsia."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"1131-3","DOI":"10.1212\/01.WNL.0000156352.61328.CB","article-title":"Case-control study of SUDEP.","volume":"64","author":"Y Langan","year":"2005","journal-title":"Neurology."},{"key":"ref-12","article-title":"Epilepsy in pregnancy: green-top guideline no. 68","year":"2016"},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"1229-36","DOI":"10.1111\/j.1528-1167.2009.02128.x","article-title":"Management issues for women with epilepsy-focus on pregnancy (an evidence-based review): I. Obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society.","volume":"50","author":"C Harden","year":"2009","journal-title":"Epilepsia."},{"key":"ref-14","doi-asserted-by":"publisher","first-page":"172-6","DOI":"10.1111\/j.1528-1167.2007.01412.x","article-title":"Seizure control in antiepileptic drug-treated pregnancy.","volume":"49","author":"F Vajda","year":"2008","journal-title":"Epilepsia."},{"key":"ref-15","doi-asserted-by":"publisher","first-page":"661-667","DOI":"10.1111\/1471-0528.14430","article-title":"Development of a core outcome set for epilepsy in pregnancy (E-CORE): a national multi-stakeholder modified Delphi consensus study.","volume":"124","author":"B Al Wattar","year":"2017","journal-title":"BJOG."},{"key":"ref-16","doi-asserted-by":"publisher","first-page":"1621-7","DOI":"10.1111\/epi.12302","article-title":"Seizure control and treatment changes in pregnancy: observations from the EURAP epilepsy pregnancy registry.","volume":"54","author":"D Battino","year":"2013","journal-title":"Epilepsia."},{"key":"ref-17","article-title":"Epilepsies: diagnosis and management","year":"2012"},{"key":"ref-18","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-002742","article-title":"Variation in severe maternal morbidity according to socioeconomic position: a UK national case-control study.","volume":"3","author":"A Lindquist","year":"2013","journal-title":"BMJ Open."},{"key":"ref-19","article-title":"Stata Statistical Software: Release 15","year":"2017"},{"key":"ref-20","doi-asserted-by":"publisher","first-page":"857-68","DOI":"10.1016\/S0140-6736(14)60932-6","article-title":"International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project.","volume":"384","author":"J Villar","year":"2014","journal-title":"Lancet."},{"key":"ref-21","article-title":"Drug Safety Update. Valproate Pregnancy Prevention Programme: actions required now from GPs, specialists, and dispensers","volume":"12","year":"2018"},{"key":"ref-22","article-title":"Maternal medicine network service specification","year":"2021"},{"key":"ref-23","article-title":"Epilepsies in children, young people and adults [NG217]","year":"2022"},{"key":"ref-24","doi-asserted-by":"publisher","first-page":"983-991","DOI":"10.1001\/jamaneurol.2017.1310","article-title":"Association between pregnancy and perinatal outcomes among women with epilepsy.","volume":"74","author":"N Razaz","year":"2017","journal-title":"JAMA Neurol."},{"key":"ref-25","doi-asserted-by":"publisher","first-page":"1845-52","DOI":"10.1016\/S0140-6736(15)00045-8","article-title":"Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis.","volume":"386","author":"L Viale","year":"2015","journal-title":"Lancet."},{"key":"ref-26","article-title":"Recommendations for digital blood pressure monitoring in maternity services","year":"2023"},{"key":"ref-27","article-title":"Diabetes in pregnancy: management from preconception to the postnatal period","year":"2015"}],"container-title":["NIHR Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/4-53\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/4-53\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/4-53\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T03:25:22Z","timestamp":1743737122000},"score":1,"resource":{"primary":{"URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/4-53\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,12]]},"references-count":27,"URL":"https:\/\/doi.org\/10.3310\/nihropenres.13743.2","relation":{"has-version":[{"id-type":"doi","id":"10.3310\/nihropenres.13743.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.3310\/nihropenres.14996.r34844","asserted-by":"subject"},{"id-type":"doi","id":"10.3310\/nihropenres.14996.r34727","asserted-by":"subject"},{"id-type":"doi","id":"10.3310\/nihropenres.14996.r34893","asserted-by":"subject"},{"id-type":"doi","id":"10.3310\/nihropenres.14996.r34727","asserted-by":"object"},{"id-type":"doi","id":"10.3310\/nihropenres.14996.r34893","asserted-by":"object"},{"id-type":"doi","id":"10.3310\/nihropenres.14996.r34844","asserted-by":"object"},{"id-type":"doi","id":"10.3310\/nihropenres.14996.r34842","asserted-by":"object"}]},"ISSN":["2633-4402"],"issn-type":[{"value":"2633-4402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,12]]},"assertion":[{"value":"Indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/4-53\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.3310\/nihropenres.14996.r34727, Neda Razaz, Karolinska Institutet, Stockholm, 24 Feb 2025, version 2, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/4-53\/v2#referee-response-34727","order":0,"name":"referee-response-34727","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.3310\/nihropenres.14996.r34844, Joan E Devin, Royal College of Surgeons in Ireland, Dublin, Leinster, 20 Mar 2025, version 2, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/4-53\/v2#referee-response-34844","order":1,"name":"referee-response-34844","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.3310\/nihropenres.14996.r34893, Masaraf Hussain, All India Institute of Medical Sciences, Guwahati, Assam, 04 Apr 2025, version 2, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/4-53\/v2#referee-response-34893","order":2,"name":"referee-response-34893","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This project is part-funded by the National Institute for Health and Care Research (NIHR) under its [\u2018NIHR Clinical Lectureship\u2019 (to Bryn Kemp) and \u2018NIHR Professorship\u2019 (to Marian Knight, Grant Reference Number NIHR-RP-011-032)]. Marian Knight is an NIHR Senior Investigator; award reference NIHR303806. This paper reports on an independent project, which is part-funded by the Policy Research Programme in the Department of Health (Grant Reference Number 108\/0001).  \n\nThe views expressed are those of the author(s) and not necessarily those of the NIHR the University of Oxford or the Department of Health and Social Care. \n\nThe funders had no role in the study design, data collection and analysis, decision to publish or preparation of the article.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}