The effectiveness of preconception counseling to reduce adverse pregnancy outcome in women with epilepsy: What’s the evidence?

Winterbottom, Janine B; Smyth, Rmd; Jacoby, Ann; Baker, Gus A.

doi:10.1016/j.yebeh.2008.11.008

Cited by 28 publications

(10 citation statements)

References 54 publications

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“…Only 25.4% of the EBCR WWE at risk consulted their neurologist regarding the selection of a contraceptive method, although 87.4% had a neurologist/epileptologist and AED interaction was identified among the top three reasons for selection of a method by 55.3%. The American Academy of Neurology has formally recognized the importance of counseling WWE of reproductive age regarding the special concerns that may apply to them in relation to contraception and pregnancy and included the discussion of these reproductive issues as a clinical quality measure . The Centers for Disease Control and Prevention and the American Academy of Neurology have also provided healthcare providers with authoritative guides for prescribing contraceptives to WWE.…”

Section: Discussionmentioning

confidence: 99%

“…The American Academy of Neurology has formally recognized the importance of counseling WWE of reproductive age regarding the special concerns that may apply to them in relation to contraception and pregnancy and included the discussion of these reproductive issues as a clinical quality measure. [31][32][33][34] The Centers for Disease Control and Prevention 35 and the American Academy of Neurology [31][32][33][34] have also provided healthcare providers with authoritative guides for prescribing contraceptives to WWE. These guides, however, are based largely on pharmacologic interactions between contraceptive methods and AEDs.…”

Section: Discussionmentioning

confidence: 99%

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Contraceptive practices of women with epilepsy: Findings of the epilepsy birth control registry

et al. 2016

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SUMMARYObjective: To report the contraceptive practices of women with epilepsy (WWE) in the community, predictors of highly effective contraception use, and reasons WWE provide for the selection of a particular method. Methods: These cross-sectional data come from the Epilepsy Birth Control Registry (EBCR) web-based survey regarding the contraceptive practices of 1,144 WWE in the community, ages 18-47 years. We report demographic, epilepsy, and antiepileptic drug (AED) characteristics as well as contraceptive use. We determined the frequency of use of highly effective contraception use, that is, methods with failure rate <10%/year, and conducted binary logistic regression analysis to determine predictors of highly effective contraception use. We report frequencies of WWE who consult various health care providers regarding the selection of a method and the reasons cited for selection. Results: Of the 796 WWE at risk of unintended pregnancy, 69.7% use what is generally considered to be highly effective contraception (hormonal, intrauterine device [IUD], tubal, vasectomy). Efficacy in WWE, especially for the 46.6% who use hormonal contraception, remains to be proven. Significant predictors of highly effective contraception use are insurance (insured 71.6% vs. noninsured 56.0%), race/ethnicity (Caucasian 71.3% vs. minority 51.0%), and age (38-47, 77.5%; 28-37, 71.8%; 18-27, 67.0%). Of the 87.2% who have a neurologist, only 25.4% consult them regarding selection of a method, although AED interaction is cited as the top reason for selection. Significance: The EBCR web-based survey is the first large-scale study of the contraceptive practices of WWE in the community. The findings suggest a need for the development of evidence-based guidelines that address the efficacy and safety of contraceptive methods in this special population, and for greater discourse between neurologists and WWE regarding contraception.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Contraceptive practices of women with epilepsy: Findings of the epilepsy birth control registry

et al. 2016

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“…The clinician needs to go beyond the prevention of pregnancy: it is necessary to discuss with the woman of childbearing potential how to plan her pregnancy, doing the pertinent AEDs and supplements adjustments; even if current evidence concerning the actual effectiveness of counseling is inconclusive [17]. …”

Section: Discussionmentioning

confidence: 99%

Impact of the implementation of the AAN epilepsy quality measures on the medical records in a university hospital

et al. 2013

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BackgroundThe American Academy of Neurology (AAN) suggested eight quality measures to be observed at every patient visit. The aim of this work is to compare the percentage of documentation of each measure before and after the implementation of a new worksheet in a third-level center.MethodsQuasi-experimental study including medical records filled by medical school seniors and junior residents supervised by an epileptologist. The authors surveyed 80 consecutive charts of people with epilepsy who were seen in the outpatient clinic before and after the intervention. McNemar change test was used to compare the percentages of documentation of each quality measure–i.e., seizure type and frequency, etiology, EEG, MRI/CT head scans, AED side effects, surgical therapy referral, safety counseling, preconception counseling–and physical exam. Each quality measure was considered to be fulfilled only if it was assessed and properly recorded.ResultsMean age was 35(±13) years, 55% women, mean epilepsy onset at age 18(±15), 82% presented with partial-onset seizures. The reporting rate improved for all quality measures (previous vs new), reaching statistical significance for: seizure type 80vs94% (p < 0.05), AED side effects 8vs24%, etiology 66vs88% (p < 0.01), safety counseling 5vs64%, preconception counseling 4vs20%, and physical exam 63vs94% (p < 0.001).ConclusionA quality-oriented epilepsy worksheet led to a better practice standardization and documentation of AAN standards for diagnostic and counseling purposes. Further evaluations should be undertaken to assess the impact on medical education and patient care.

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“…Promising findings include a meta-analysis indicating that preconception intervention in women with pregestational diabetes reduces the incidence of major and minor congenital anomalies 20 and a case-control analysis from a randomized trial suggesting that preconception folic acid intervention reduces the incidence of anomalies in women with epilepsy. 21 Adoption of PCC in practice has been limited by several factors, including the slow growth of clinical trials or health services research to inform implementation, inadequate provider training, and insufficient reimbursement for preventive care services. 22,23 PCC as part of a well-woman visit became available without co-payment in 2012 through the Affordable Care Act; however, the impact of this policy change on delivery of PCC remains unclear.…”

Section: Preconception Care Backgroundmentioning

confidence: 99%

Preconception Care in the Veterans Health Administration

et al. 2018

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Preconception care (PCC), defined as a set of interventions to help women optimize their health and well-being prior to pregnancy, can improve pregnancy outcomes and is recommended by national organizations including the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists. Women Veterans who use the Department of Veterans Affairs (VA) health care system may face elevated risks of adverse pregnancy and birth outcomes due to a high prevalence of chronic medical and mental health conditions as well as psychosocial stressors including sexual trauma history and intimate partner violence. Many women Veterans of childbearing age experience poverty and homelessness, which are key social determinants of poor reproductive health outcomes. Furthermore, racial/ethnic disparities in maternal and neonatal outcomes are well documented, and nearly half of women Veterans of reproductive age are minority race/ethnicity. High-quality, equitable, patient-centered PCC services to address modifiable risks in this population are therefore a priority for VA. In this article, we provide a brief background of PCC, discuss the health risks of Veterans associated with adverse pregnancy outcomes, and highlight VA initiatives related to PCC. Lastly, we discuss implications and future directions for PCC research and policy within VA and across other health systems.

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The effectiveness of preconception counseling to reduce adverse pregnancy outcome in women with epilepsy: What’s the evidence?

Cited by 28 publications

References 54 publications

Contraceptive practices of women with epilepsy: Findings of the epilepsy birth control registry

Contraceptive practices of women with epilepsy: Findings of the epilepsy birth control registry

Impact of the implementation of the AAN epilepsy quality measures on the medical records in a university hospital

Preconception Care in the Veterans Health Administration

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