To determine how pre-conception care (PCC) influenced the outcome of epilepsy, pregnancy and malformation risk in women with epilepsy (WWE).All primigravida in the Kerala registry of epilepsy and pregnancy (KREP) with the final outcome of pregnancy known who were enrolled prospectively in pre-conception stage (PCC group) or first trimester of pregnancy (PRG group) were included. The two groups were compared for fetal and maternal outcomes including seizure control and complications of pregnancy.There were 320 (30.4 %) in PCC group and 732 in PRG group. Both groups were comparable for epilepsy classification, maternal birth defects and family history of epilepsy but the PCC group had significantly higher education (48.9 %, p = .027) and employment (22.1 %, p < .001). They had higher usage of folate in pre-pregnancy month (87.5 %, p < .001) and first trimester (96.3 %, p < .001) than PRG group. Fewer women in the PCC group were off AEDs in first trimester (5 % vs 9.3 %, p = .018). Within monotherapy group, use of levetiracetam (10.8 %, p = .017), valproate (34 %, p = .002) in PCC group and carbamazepine (39.1 %, p = .04), phenobarbitone (13.3 %, p = .001) in PRG group was significantly high. More women in PCC group were seizure free during pregnancy (62.8 %, p = .005) than PRG group. Early fetal loss was better captured in PCC (90.6 %,p = .025) than in the PRG. There was no difference in malformation rate between PCC (7.2 %) and PRG groups (6.1 %, p = .3).PCC reduced the risk of seizures during pregnancy and improved the periconceptional use of folate but did not influence the fetal malformation risk.
