Preconception counselling for women with epilepsy to reduce adverse pregnancy outcome

Winterbottom, JB; Smyth, Rmd; Jacoby, Ann; Baker, GA

doi:10.1002/14651858.cd006645

Cited by 7 publications

(8 citation statements)

References 32 publications

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“…The review also looked for any preconception intervention which worked in lowering the maternal, newborn and child health (MNCH) risks associated with poorly controlled phenyalanine levels. Preconception care of women with PKU consists of counseling regarding the fetal risks (facial malformations, growth deficits, micorcephaly) associated with the disease, commencement of a phenylalanine restricted diet, attaining safe phenylalanine levels (100 [ 71 ] –360μmol/L [ 72 ] or <6mg/dL [ 73 , 74 ] atleast 3 months before conception; and maintaining them throughout gestation). When counseling patients great importance has to be put on the need for effective contraception till such safe levels are reached.…”

Section: Management Of Phenylketonuriamentioning

confidence: 99%

Preconception care: screening and management of chronic disease and promoting psychological health

et al. 2014

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IntroductionA large proportion of women around the world suffer from chronic diseases including mental health diseases. In the United States alone, over 12% of women of reproductive age suffer from a chronic medical condition, especially diabetes and hypertension. Chronic diseases significantly increase the odds for poor maternal and newborn outcomes in pregnant women.MethodsA systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for preventing and managing chronic diseases and promoting psychological health on maternal, newborn and child health outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture.ResultsMaternal prepregnancy diabetic care is a significant intervention that reduces the occurrence of congenital malformations by 70% (95% Confidence Interval (CI): 59-78%) and perinatal mortality by 69% (95% CI: 47-81%). Furthermore, preconception management of epilepsy and phenylketonuria are essential and can optimize maternal, fetal and neonatal outcomes if given before conception. Ideally changes in antiepileptic drug therapy should be made at least 6 months before planned conception. Interventions specifically targeting women of reproductive age suffering from a psychiatric condition show that group-counseling and interventions leading to empowerment of women have reported non-significant reduction in depression (economic skill building: Mean Difference (MD) -7.53; 95% CI: -17.24, 2.18; counseling: MD-2.92; 95% CI: -13.17, 7.33).ConclusionWhile prevention and management of the chronic diseases like diabetes and hypertension, through counseling, and other dietary and pharmacological intervention, is important, delivering solutions to prevent and respond to women’s psychological health problems are urgently needed to combat this leading cause of morbidity.

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Section: Management Of Phenylketonuriamentioning

confidence: 99%

Preconception care: screening and management of chronic disease and promoting psychological health

et al. 2014

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“…Epilepsy is a common neurological condition characterised by recurrent seizures, 1 with an annual incidence varying between 40 and 80 per 100 000 worldwide 2,3 . Women with epilepsy are assumed to account for 0.3–0.7% of all pregnancies in developed countries 4–7 .…”

Section: Introductionmentioning

confidence: 99%

Obstetric outcome in women with epilepsy: a hospital-based, retrospective study

Borthen

Eide

Daltveit

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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Objective To report the complications during pregnancy and delivery in women with epilepsy, compared with a control group without epilepsy, with special focus on potential risk factors, such as epilepsy severity and dosage of antiepileptic drugs.Design Hospital-based retrospective study.Setting Data from pregnancy notification forms and hospital case records.Population Women with a past or present history of epilepsy (n = 205) delivered in Bergen, Norway, in the period 1999-2006, and a matched control group of women (n = 205) without epilepsy.Methods Data were compared and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by multiple logistic regression models.Main outcome measures Pre-eclampsia (mild and severe), gestational hypertension, vaginal bleeding (early and late), caesarean section, vaginal operative delivery, postpartum haemorrhage and major malformations.Results Women with epilepsy using antiepileptic drugs had an increased risk of severe pre-eclampsia (OR, 5.0; 95% CI, 1.3-19.9), bleeding in early pregnancy (OR, 6.4; 95% CI, 2.7-15.2), induction (OR, 2.3; 95% CI, 1.2-4.3) and caesarean section (OR, 2.5; 95% CI, 1.4-4.7) adjusted for maternal age, parity, education, smoking, medical conditions and body mass index ‡30 kg/m 2 . There was also an increased risk of malformations in the offspring (OR, 7.1; 95% CI, 1.4-36.6). Women without antiepileptic drug use had increased risks of forceps delivery and preterm birth. Active epilepsy (seizures during the last 5 years) versus nonactive epilepsy did not discriminate for any of these complications; 84.5% of women with epilepsy and antiepileptic drug use were using folate.Conclusion Women with epilepsy using antiepileptic drugs had an increased risk of pregnancy and delivery complications, whereas women not using antiepileptic drugs had few complications. Seizures, high doses of antiepileptic drugs, obesity and lack of folate could not explain these increased risks.Keywords Antiepileptic drugs, delivery, epilepsy, pregnancy.Please cite this paper as: Borthen I, Eide M, Daltveit A, Gilhus N. Obstetric outcome in women with epilepsy: a hospital-based, retrospective study. BJOG 2011;118:956-965.

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“…14 This should involve coordinated interdisciplinary communication between neurologists, physicians, general practitioners and obstetricians; however, as up to half of all pregnancies are unplanned, it is imperative that this discussion forms an opportunistic part of the consultation for every woman with epilepsy of childbearing age. 2,14 Effective counselling aims to allow for informed decisions to be made regarding pregnancy, and for pregnancy to be planned at a time when maternal health is stable and frequency of seizures is minimal to optimise pregnancy outcomes ( Table 2). 14,15 Such counselling should involve specific goals that include general health promotion.…”

Section: Why Is Pre-conception Care Important and What Elements Shoulmentioning

confidence: 99%

“…2,14 Effective counselling aims to allow for informed decisions to be made regarding pregnancy, and for pregnancy to be planned at a time when maternal health is stable and frequency of seizures is minimal to optimise pregnancy outcomes ( Table 2). 14,15 Such counselling should involve specific goals that include general health promotion. 16 Table 2.…”

Section: Why Is Pre-conception Care Important and What Elements Shoulmentioning

confidence: 99%

The management of pregnant women with epilepsy: a multidisciplinary collaborative approach to care

Bhatia

Adcock

Mackillop

2017

The Obstetric & Gynaecologis

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Key content Epilepsy is the most common serious neurological problem encountered in pregnancy; however, women with epilepsy are often not referred to high‐risk pregnancy services. The 2015 Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE‐UK) report on maternal mortality highlights that the care of pregnant women with epilepsy requires urgent improvement. The two most recently available guidelines (Scottish Intercollegiate Guidelines Network and Royal College of Obstetricians and Gynaecologists guidelines) require comparative critical appraisal. Collaboration between general practitioners, specialist epilepsy nurses/midwives, obstetricians, obstetric physicians, neurologists and anaesthetists is vital to ensure optimal standardised management. Learning objectives To understand the role of pre‐conception counselling: to include advice on seizure control, anti‐epileptic drugs (AEDs) and pre‐conception folic acid. To understand the risk factors associated with poor outcomes in pregnant women with epilepsy. To understand the risks associated with specific types of AEDs: mono‐ and polytherapy. To understand the issues regarding the titration of AEDs during pregnancy, postnatal and breastfeeding periods. To understand the importance of a multidisciplinary antenatal, intrapartum and postnatal schedule of care and special considerations. Ethical issues When should we advise women to avoid pregnancy? When, how and by whom should AEDs be modified? Are women with epilepsy aware of the risk of sudden unexpected death in epilepsy in pregnancy?

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Preconception counselling for women with epilepsy to reduce adverse pregnancy outcome

Cited by 7 publications

References 32 publications

Preconception care: screening and management of chronic disease and promoting psychological health

Preconception care: screening and management of chronic disease and promoting psychological health

Obstetric outcome in women with epilepsy: a hospital-based, retrospective study

The management of pregnant women with epilepsy: a multidisciplinary collaborative approach to care

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