{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:34:16Z","timestamp":1785425656472,"version":"3.56.0"},"reference-count":41,"publisher":"AOSIS","issue":"2","license":[{"start":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T00:00:00Z","timestamp":1771632000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Epilepsy 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.\nMethods:\u00a0A 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,\u00a0N\u00a0= 90 met the inclusion criteria. Data were extracted into Microsoft Excel\u00ae\u00a0and analysed using SPSS\u00ae\u00a0(v29). Descriptive and inferential analyses (chi-square, Fisher\u2019s exact, Spearman\u2019s correlation, Mann\u2013Whitney U and logistic regression) were used to assess the associations between variables.\nResults:\u00a0Sodium valproate was prescribed to 60% of patients in the cohort. Folic acid supplementation was documented in 70% of cases (n\u00a0= 63). Sodium valproate use was significantly associated with polytherapy (p\u00a0= 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\u2019s \u03c1 = 0.74,\u00a0p\u00a0&lt; 0.001).\nConclusion:\u00a0The 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.\nContribution:\u00a0This 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.<\/jats:p>","DOI":"10.4102\/safp.v68i2.6223","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T14:31:19Z","timestamp":1771511479000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of the management of high-risk obstetric patients living with epilepsy: A retrospective study from KwaZulu-Natal, South Africa"],"prefix":"10.4102","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3354-6522","authenticated-orcid":false,"given":"Sumeshni","family":"Birbal","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3691-7446","authenticated-orcid":false,"given":"Frasia","family":"Oosthuizen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3937-2667","authenticated-orcid":false,"given":"Urisha","family":"Naidoo","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,2,21]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Makhado L, Maphula A, Ngomba RT, et al. 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