Women’s Neurology: Pregnancy, epilepsy and MS
In our research at Karolinska Institutet, we study how pregnancy and neurological conditions affect each other — and how care can be improved. Pregnancy is a time of profound biological change, and women living with these conditions have historically been excluded from the studies that should guide their care. Our research aims to close that gap.
We work at the intersection of neurology, obstetrics, and clinical epidemiology, combining direct involvement of women through our prospective registry with the large-scale evidence available through Sweden’s national health registers.
Our aim is to generate evidence that helps women, families, and clinicians make better-informed decisions before, during, and after pregnancy.
Epilepsy and pregnancy
Our research at Karolinska Institutet investigates how pregnancy and neurological conditions affect each other in women living with epilepsy or multiple sclerosis. Many of our research questions can only be answered with women's direct involvement. With consent, we collect clinical information, blood samples, and other biological samples at routine clinical visits, and follow what happens during pregnancy and afterwards. Women can take part in different ways and at different levels of involvement.
Life-course and medication safety
A pregnancy is rarely a one-off event. Decisions made before pregnancy — about which medication to take, at what dose, and for how long — affect the pregnancy itself, the early weeks of a child's life, and sometimes their development for years afterwards. Our research follows this whole arc. We compare the safety of different anti-seizure medications and MS therapies; we study how pregnancy itself changes the course of these diseases; and we examine the long-term health of children whose mothers used these treatments.
Why we are doing this work
Around one in 250 pregnant women in Sweden has epilepsy, and most need to continue anti-seizure medication during pregnancy to stay safe. The number of pregnancies in women with epilepsy in Sweden has risen by around 35% between 2002 and 2019. Yet evidence on the safety of different medications, especially newer ones and combinations, remains incomplete — and women living with epilepsy have often been excluded from the studies that should guide their care.
Our research questions
- Which anti-seizure medications and dosing strategies are safest during pregnancy and breastfeeding?
- How can we identify, early in pregnancy, which women may need closer follow-up?
- What are the long-term effects on children whose mothers used different anti-seizure medications during pregnancy?
What we are doing
Our work in this area combines three approaches:
- Early pregnancy biomarkers — using a small blood sample taken at the routine 11–14 week scan to look at signals from the placenta that may indicate higher pregnancy risk.
- Newborn dried blood spot signatures — using the routine PKU heel-prick sample to study how anti-seizure medication exposure leaves measurable signatures, and what those signatures tell us about future development.
- Multinational register research — comparing outcomes across Sweden, Norway, Denmark, Finland, Iceland and Canada to build personalised risk estimates.
Funding
This work is supported by the Karolinska Institutet Consolidator Award, and ALF Medicine Stockholm with collaborators across the Nordic countries and Canada. Additional funding applications are under review.
MS and pregnancy
Why we are doing this work
Multiple sclerosis affects more women than men, and most are diagnosed during their reproductive years. Pregnancy can change how MS behaves, with reduced relapse rates during pregnancy and a sharply increased risk of relapse in the early postpartum period. Many MS treatments still lack robust safety information for use around pregnancy and breastfeeding, leaving women and their clinicians making important decisions on the basis of incomplete evidence.
Our research questions
- How do MS disease-modifying therapies affect pregnancy outcomes, infant immunity, and child development?
- How does pregnancy itself change the course of MS, and how can postpartum relapses be prevented?
- Are some therapies safer than others around pregnancy and breastfeeding, and what are the long-term effects of in-utero or early-life exposure to immunomodulatory drugs?
What we are doing
Our work in this area uses the Swedish MS Registry, the Medical Birth Register, and the routine newborn PKU sample to study:
- The effects of pausing high-efficacy therapies such as natalizumab and rituximab around pregnancy.
- The development of infant immunity in babies whose mothers used anti-CD20 therapies during pregnancy.
- Maternal mental health and postpartum outcomes in mothers with MS.
Data sources and linked Swedish health registers
A large part of our research is based on real-world data from Sweden’s national health registers, including the National Medical Birth Register, the National Patient Register, the National Cause of Death Register, and the National Prescribed Drug Register, alongside disease-specific quality registers including the Swedish Epilepsy Register, and the Swedish MS Registry.
By linking these registers under approval from the Swedish Ethical Review Authority and protected under EU privacy law, we can follow what happens to thousands of women and children over many years without asking them for any extra time. This is what makes it possible to detect rare effects, to follow children into school age and beyond, and to compare different treatments fairly.
We also use data from corresponding registers in other countries, especially the Nordic countries, and biospecimens collected through our prospective Pregnancy Neurology Registry & Biobank.
Swedish health registers
Publications and findings
Recent findings:
- The 2024 Nordic cohort study on maternal and perinatal outcomes in pregnancies of women with epilepsy (JAMA Neurology).
- The 2026 national study of children's epilepsy risk in relation to maternal chronic disease (BMC Medicine).
- The 2020 study on disease activity following rituximab and natalizumab suspension in MS pregnancies.
- The 2023 Multiple Sclerosis paper on adverse perinatal outcomes associated with MS disease-modifying drugs.
- The 2025 paper on peripartum mental illness in mothers with MS.
Peer-reviewed papers in scientific journals
Marrie RA, Maxwell CJ, Bolton JM, Söderling J, Bernstein CN, Krysko KM, McKay KA, Rotstein D, Deakin-Harb K, Razaz N. Incident and prevalent peripartum mental illness in mothers with multiple sclerosis and other chronic diseases in Sweden. Multiple sclerosis and related disorders 2026 107; 107041-
Hossin MZ, Persson M, Bjørk MH, Stephansson O, Razaz N. Intrauterine exposure to maternal diabetes and the risk of developing epilepsy in children: a national cohort study of 2.3 million children. BMC medicine 2026 24;1
Rajasingham M, Lisonkova S, Razaz N, Muraca GM. Long-Term Neurodevelopmental Outcomes After Forceps, Vacuum, and Second-Stage Cesarean Delivery. JAMA Netw Open. 2026 Jan 2;9(1):e2556637.
Campbell M, Wen Q, Muraca GM, Razaz N, Joseph KS, Lisonkova S. Maternal Deaths Following Severe Maternal Morbidity During Childbirth in Canada. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2026 48;6 103268-
Razaz N, Soderling J, Tomson T, Werenberg Dreier J, Christensen J, Bjørk MH, Igland J. Risk of neurodevelopmental disorders associated with paternal use of valproate during spermatogenesis. Journal of neurology, neurosurgery, and psychiatry 2026 ;
Christensen J, Trabjerg BB, van Gelder MMHJ, Meng LC, Lai HY, Igland J, Razaz N, Tomson T, Bjørk MH, Hsiao FY, Nordeng HME, Dreier JW. Risk of neurodevelopmental disorders associated with paternal use of valproate during spermatogenesis: a living meta-analysis-version 1. Journal of neurology, neurosurgery, and psychiatry 2026 ;
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Tsamantioti E, Joseph KS, Ananth CV, Remaeus K, Sandström A, Razaz N. Severe maternal morbidity and risk of adverse pregnancy, delivery, and neonatal outcomes in the subsequent delivery. American journal of obstetrics and gynecology 2026 234;4 1232-1255
Sun YL, Alvestad S, Cohen JM, Igland J, Gilhus NE, Vegrim HM, Tomson T, Christensen J, Leinonen MK, Gissler M, Zoega H, Razaz N, Dreier JW, Bjork MH. Timing of high-dose folic acid supplementation in the periconceptional period among women taking antiseizure medications and risk of major congenital anomalies: a target trial emulation. JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY 2026 97;6 542-552
Tsamantioti E, Sandstroem A, Wollmann CL, Snowden JM, Razaz N. Association of Severe Maternal Morbidity With Subsequent Birth. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 2025 333;2 133-142
Lundborg L, Ananth CV, Joseph KS, Cnattingius S, Razaz N. Changes in the prevalence of maternal chronic conditions during pregnancy: A nationwide age-period-cohort analysis. BJOG : an international journal of obstetrics and gynaecology 2025 132;1 44-52
Kabwama SN, Wanyenze RK, Lindgren H, Razaz N, Ssenkusu JM, Alfvén T. Interventions to Maintain HIV/AIDS, Tuberculosis, and Malaria Service Delivery During Public Health Emergencies in Low- and Middle-Income Countries: Protocol for a Systematic Review. JMIR research protocols 2025 14; e64316-
Kabwama SN, Razaz N, Ssenkusu JM, Lindgren H, Wanyenze RK, Driwale A, Alfvén T. Maintenance of service delivery during medical countermeasures deployment: The association between the COVID-19 vaccine rollout and continuity of routine childhood immunization services in Uganda. PLOS global public health 2025 5;6 e0004731-
Tsamantioti E, Alfvén T, Hossin MZ, Razaz N. Maternal anaemia and risk of neonatal and infant mortality in low- and middle-income countries: a secondary analysis of 45 national datasets. BMJ global health 2025 10;3
Walås A, Simatou E, Andersson Franko M, Persson M, Stephansson O, Razaz N, Sundelin HEK, Bolk J. Maternal Overweight and Obesity and Risk of Perinatal Ischemic Stroke: A Nationwide Cohort Study. Neurology 2025 104;6 e213333-
Suárez-Idueta L, Blencowe H, Okwaraji YB, Yargawa J, Bradley E, Gordon A, Flenady V, Paixao ES, Barreto ML, Lisonkova S, Wen Q, Velebil P, Jírová J, Horváth-Puhó E, Sørensen HT, Sakkeus L, Abuladze L, Yunis KA, Al Bizri A, Barranco A, Broeders L, van Dijk AE, Alyafei F, Olukade TO, Razaz N, Söderling J, Smith LK, Draper ES, Lowry E, Rowland N, Wood R, Monteath K, Pereyra I, Pravia G, Ohuma EO, Lawn JE, National Vulnerable Newborn Mortality Collaborative Group and Vulnerable Newborn Measurement Core Group. Neonatal mortality risk for vulnerable newborn types in 15 countries using 125.5 million nationwide birth outcome records, 2000-2020. BJOG : an international journal of obstetrics and gynaecology 2025 132 Suppl 8; S37-S47
Suárez-Idueta L, Ohuma EO, Chang CJ, Hazel EA, Yargawa J, Okwaraji YB, Bradley E, Gordon A, Sexton J, Lawford HLS, Paixao ES, Falcão IR, Lisonkova S, Wen Q, Velebil P, Jírová J, Horváth-Puhó E, Sørensen HT, Sakkeus L, Abuladze L, Yunis KA, Al Bizri A, Alvarez SL, Broeders L, van Dijk AE, Alyafei F, AlQubaisi M, Razaz N, Söderling J, Smith LK, Matthews RJ, Lowry E, Rowland N, Wood R, Monteath K, Pereyra I, Pravia G, Lawn JE, Blencowe H, National Vulnerable Newborn Mortality Collaborative Group and the Vulnerable Newborn Measurement Core Group. Neonatal mortality risk of large-for-gestational-age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000-2020. BJOG : an international journal of obstetrics and gynaecology 2025 132 Suppl 8; S109-S120
Graham H, Razaz N, Håkansson S, Blomqvist YT, Johansson K, Persson M, Nyholm A, Norman M. Pain in very preterm infants-prevalence, causes, assessment, and treatment. A nationwide cohort study. Pain 2025 166;8 1882-1892
Marrie RA, Bolton J, Ling YV, Bernstein C, Krysko KM, Li P, Mckay KA, Pequeno P, Razaz N, Rotstein D, Deakin-Harb K, Maxwell CJ. Peripartum Mental Illness in Mothers With Multiple Sclerosis and Other Chronic Diseases in Ontario, Canada. Neurology 2025 104;4 e210170-
Razaz N, Fernandez de la Cruz L. Pregnancy, Delivery, and Neonatal Outcomes in Women with Tourette Syndrome or Chronic Tic Disorder. MOVEMENT DISORDERS 2025 40;12 2830-2835
Marrie RA, Bolton JM, Ling V, Bernstein CN, Krysko KM, Li P, McKay KA, Razaz N, Rotstein DL, Deakin-Harb K, Maxwell C. Risk factors for incident peripartum mental illness in multiple sclerosis. Multiple sclerosis (Houndmills, Basingstoke, England) 2025 31;7 846-855
Joseph KS, Lisonkova S, Muraca GM, Henderson I, Wainstock T, Razaz N, Carmichael SL, Knight M, Yoles I. Severe Maternal Morbidity: Fundamental Concepts. CURRENT EPIDEMIOLOGY REPORTS 2025 12;1
Razaz N, Bolk J, Graham H, Tsamantioti E, Johansson K, Persson M, Norman M. Severe Neonatal Morbidity Across Gestational Age: Monitoring Infants at High Risk of Mortality. Acta paediatrica (Oslo, Norway : 1992) 2025 114;8 1847-1856
Graham H, Johansson K, Persson M, Norman M, Razaz N. Severe Neonatal Morbidity and All-Cause and Cause-Specific Mortality Through Infancy and Late Adolescence. JAMA pediatrics 2025 179;9 1017-1025
Okwaraji YB, Suarez-Idueta L, Ohuma EO, Bradley E, Yargawa J, Pingray V, Cormick G, Gordon A, Flenady V, Horvath-Puho E, Sorensen HT, Abuladze L, Heidarzadeh M, Khalili N, Yunis KA, Al Bizri A, Barranco A, van Dijk AE, Broeders L, Alyafei F, Olukade TO, Razaz N, Soderling J, Smith LK, Matthews RJ, Wood R, Monteath K, Pereyra I, Pravia G, Lisonkova S, Wen Q, Lawn JE, Blencowe H, Natl Vulnerable Newborn Mortality Collaborative Grp, 15 Vulnerable Newborn Measurement Core Grp. Stillbirth risk by fetal size among 126.5 million births in 15 countries from 2000 to 2020: A fetuses-at-risk approach. BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2025 132; S85-S96
Okwaraji YB, Suárez-Idueta L, Ohuma EO, Bradley E, Yargawa J, Pingray V, Cormick G, Gordon A, Flenady V, Horváth-Puhó E, Sørensen HT, Sakkeus L, Abuladze L, Heidarzadeh M, Khalili N, Yunis KA, Al Bizri A, Karalasingam SD, Jeganathan R, Barranco A, van Dijk AE, Broeders L, Alyafei F, AlQubaisi M, Razaz N, Söderling J, Smith LK, Matthews RJ, Wood R, Monteath K, Pereyra I, Pravia G, Lisonkova S, Wen Q, Lawn JE, Blencowe H, National Vulnerable Newborn Collaborative Group for Stillbirths. Stillbirths: Contribution of preterm birth and size-for-gestational age for 125.4 million total births from nationwide records in 13 countries, 2000-2020. BJOG : an international journal of obstetrics and gynaecology 2025 132 Suppl 8; S73-S84
Nguyen THH, Hossin MZ, Schmauder S, Muraca GM, Lisonkova S, Razaz N. Timing of Delivery of Low-Risk Persons and the Risk of Attention-Deficit Hyperactivity Disorder in Offspring: Sweden and British Columbia, Canada. PAEDIATRIC AND PERINATAL EPIDEMIOLOGY 2025 39;4 356-369
Suárez-Idueta L, Yargawa J, Blencowe H, Bradley E, Okwaraji YB, Pingray V, Gibbons L, Gordon A, Warrilow K, Paixao ES, Falcão IR, Lisonkova S, Wen Q, Mardones F, Caulier-Cisterna R, Velebil P, Jírová J, Horváth-Puhó E, Sørensen HT, Sakkeus L, Abuladze L, Gissler M, Heidarzadeh M, Moradi-Lakeh M, Yunis KA, Al Bizri A, Karalasingam SD, Jeganathan R, Barranco A, Broeders L, van Dijk AE, Huicho L, Quezada-Pinedo HG, Cajachagua-Torres KN, Alyafei F, AlQubaisi M, Cho GJ, Kim HY, Razaz N, Söderling J, Smith LK, Kurinczuk J, Lowry E, Rowland N, Wood R, Monteath K, Pereyra I, Pravia G, Ohuma EO, Lawn JE, National Vulnerable Newborn Prevalence Collaborative Group and Vulnerable Newborn Measurement Core Group. Vulnerable newborn types: Analysis of population-based registries for 165 million births in 23 countries, 2000-2021. BJOG : an international journal of obstetrics and gynaecology 2025 132 Suppl 8; S5-S19
Hossin MZ, de la Cruz LF, McKay KA, Oberlander TF, Sandström A, Razaz N. Association of pre-existing maternal cardiovascular diseases with neurodevelopmental disorders in offspring: a cohort study in Sweden and British Columbia, Canada. International journal of epidemiology 2024 53;1
Joseph KS, Lisonkova S, Simon S, John S, Razaz N, Muraca GM, Boutin A, Bedaiwy MA, Brandt JS, Ananth CV. Effect of the COVID-19 Pandemic on Stillbirths in Canada and the United States. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2024 46;4 102338-
Kabwama SN, Wanyenze RK, Razaz N, Ssenkusu JM, Alfvén T, Lindgren H. How interventions to maintain services during the COVID-19 pandemic strengthened systems for delivery of maternal and child health services: a case-study of Wakiso District, Uganda. Global health action 2024 17;1 2314345-
Joseph KS, Lisonkova S, Boutin A, Muraca GM, Razaz N, John S, Sabr Y, Chan WS, Mehrabadi A, Brandt JS, Schisterman EF, Ananth CV. Maternal mortality in the United States: are the high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance?. American journal of obstetrics and gynecology 2024 230;4 440.e1-440.e13
Mitha A, Chen R, Razaz N, Johansson S, Stephansson O, Altman M, Bolk J. Neurological development in children born moderately or late preterm: national cohort study. BMJ (Clinical research ed.) 2024 384; e075630-
Hossin MZ, Kazamia K, Faxén J, Rudolph A, Johansson K, Sandström A, Razaz N. Pre-existing maternal cardiovascular disease and the risk of offspring cardiovascular disease from infancy to early adulthood. European heart journal 2024 45;38 4111-4123
Wang LQ, Bone JN, Muraca GM, Razaz N, Joseph KS, Lisonkova S. Prepregnancy body mass index and other risk factors for early-onset and late-onset haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome: a population-based retrospective cohort study in British Columbia, Canada. BMJ open 2024 14;3 e079131-
Razaz N, Igland J, Bjørk MH, Joseph KS, Dreier JW, Gilhus NE, Gissler M, Leinonen MK, Zoega H, Alvestad S, Christensen J, Tomson T. Risk of Perinatal and Maternal Morbidity and Mortality Among Pregnant Women With Epilepsy. JAMA neurology 2024 81;9 985-995
Tsamantioti E, Sandstrom A, Muraca GM, Joseph KS, Remaeus K, Razaz N. Severe maternal morbidity surveillance, temporal trends and regional variation: A population-based cohort study. BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2024 131;6 811-822
Joseph KS, Lisonkova S, Boutin A, Muraca GM, Razaz N, John S, Sabr Y, Simon S, Kögl J, Suarez EA, Chan WS, Mehrabadi A, Brandt JS, Schisterman EF, Ananth CV. Spatiotemporal patterns and surveillance artifacts in maternal mortality in the United States: a population-based study. Lancet regional health. Americas 2024 39; 100902-
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Lundborg L, Joseph KS, Lisonkova S, Chan WS, Wen Q, Ananth CV, Razaz N. Temporal changes in pre-existing health conditions five years prior to pregnancy in British Columbia, Canada, 2000-2019. PAEDIATRIC AND PERINATAL EPIDEMIOLOGY 2024 38;5 383-393
Razaz N, Allen VM, Fahey J, Joseph KS. Antenatal Corticosteroid Prophylaxis at Late Preterm Gestation: Clinical Guidelines Versus Clinical Practice. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2023 45;5 319-326
Yearwood L, Bone JN, Wen Q, Muraca GM, Lyons J, Razaz N, Joseph KS, Lisonkova S. Does maternal stature modify the association between infants who are small or large for gestational age and adverse perinatal outcomes? A retrospective cohort study. BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2023 130;5 464-475
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Partners & Network
- Karolinska University Hospital — Clinical home for the Pregnancy Neurology Registry & Biobank, with neurology, obstetrics, midwifery, neonatology, and paediatrics working together.
- Swedish Epilepsy Research Consortium — National network supporting recruitment and disease-specific data collection in epilepsy research.
- Swedish MS Registry — National quality registry providing the foundation for our MS pregnancy research.
- University of Bergen, Norway — Nordic register research on epilepsy and pregnancy.
- Aarhus University, Denmark — Nordic register research and harmonisation.
- University of British Columbia, Canada — Transatlantic register research and external validation of prediction models.
Contact us
If you would like to know more about our research, you are very welcome to contact us. We are always glad to hear from women with lived experience of epilepsy or MS, clinicians, and other researchers. There is no obligation — getting in touch is simply a way to learn more about what we are doing.
Neda Razaz
Associate Professor and Senior Lecturer at the Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet.Katarina Fink
Senior Consultant Neurologist and Research Group Leader, Neuroepidemiology Group, Karolinska Institutet.Contact me for clinical and MS-related enquiries.
For prospective collaborators
Approved researchers can apply to use data and biospecimens from the Pregnancy Neurology Registry & Biobank. All applications are reviewed by our data access committee, which includes clinical and patient representatives. Please contact us for information about the application process.