The preconception care experiences of women with epilepsy on sodium valproate

Lawther, Lorna; Dolk, Helen; Sinclair, Marlene; Morrow, Jim

doi:10.1016/j.seizure.2018.05.003

Cited by 13 publications

(9 citation statements)

References 19 publications

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“…trol group), one woman was well informed and had a good understanding of the outcome, whereas the other was uninformed up until the point of participation in the study. We support the call for a clear preconception care pathway needed from the point of epilepsy diagnosis 47. There are a number of strengths of this study.…”

supporting

confidence: 57%

“…Of the two patients whose children were possibly affected by the AED (both in the control group), one woman was well informed and had a good understanding of the outcome, whereas the other was uninformed up until the point of participation in the study. We support the call for a clear preconception care pathway needed from the point of epilepsy diagnosis …”

Section: Discussionmentioning

confidence: 69%

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Treatment decisions in women of childbearing age on valproate

2020

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Introduction There are little data on the understanding and participation of women of childbearing age in decisions about their choice of antiepileptic drugs (AEDs). Valproate carries a risk of major congenital malformations, developmental and behavioural delay. For some, valproate is the only medication to prevent potentially life‐threatening seizures. Materials & Methods This was a cross‐sectional study of two groups of women of childbearing age; 50 taking valproate and 50 controls. Each patient completed a patient questionnaire and structured telephone interview assessing understanding of the risks and benefits of AEDs in relation to pregnancy. Analysis used unpaired two‐tailed t test and chi‐squared test, with Bonferroni correction. Follow‐up at 12 months showed that 8% of the women taking valproate had switched to other medication. Results Hundred patients participated in the study, 89 on AEDs for epilepsy, 4 for migraine, and 7 for both. 55% of participants stated they were not involved in decision‐making. More patients in the valproate group were informed about (64% vs 42%, P < .005), and expressed understanding of (64%vs 32%, P < .001), the risks involved with treatment. 59% of all patients wanted more information. The minority of women surveyed took folic acid (37%) or used contraceptives (29%). Valproate was used following failure of other AEDs to control seizures in 80%. Discussion This in‐depth survey suggests more information is needed for women taking AEDs, using a range of formats. Women taking valproate are better informed than those on levetiracetam or lamotrigine. Information provision on the use of folic acid and contraception needs improvement.

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supporting

confidence: 57%

Section: Discussionmentioning

confidence: 69%

Treatment decisions in women of childbearing age on valproate

2020

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“…This has implications for pre-pregnancy counseling. To date, healthcare for women with epilepsy has paid little attention to continued monitoring of children of mothers with epilepsy [47]. It is essential that children of mothers with epilepsy be followed over time.…”

Section: Discussionmentioning

confidence: 99%

Neurocognition after prenatal levetiracetam, lamotrigine, carbamazepine or valproate exposure

et al. 2020

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Objective To examine neurocognitive functioning of children exposed prenatally to carbamazepine, lamotrigine, levetiracetam or valproate monotherapy. Methods In a prospective observational study, children aged 6 or 7 years, identified from the European Registry of Antiepileptic Drugs and Pregnancy database in The Netherlands, were assessed using the Wechsler Intelligence Scale for Children and the developmental neuropsychological assessment. Maternal IQ was measured using Wechsler Adult Intelligence Scale. Assessors were blinded to drug exposures. Results One hundred and sixty-one children (one set of twins and 21 sibling pairs) of 139 mothers were included. As a group, children achieved average scores on neurocognitive outcomes. Children exposed to valproate (n = 22) performed lower on all six neurocognitive domains, especially language, than those exposed to carbamazepine (n = 32), lamotrigine (n = 82) or levetiracetam (n = 25). After controlling for maternal IQ and drug dose, the verbal IQ of valproate-exposed children was on average 9.1 points lower than those exposed to carbamazepine (95% confidence interval [CI] 1.3-17.0; p = 0.023), 10.3 lower than lamotrigine-exposed children (CI 3.4-17.3; p = 0.004) and 13.4 lower than levetiracetam-exposed children (CI 5.2-21.6; p = 0.002). No significant dose-effect was found. Virtually no significant differences were found between lamotrigine and levetiracetam or lamotrigine and carbamazepine exposed children. Conclusions Consistent with previous research, valproate-exposed children experienced more problems compared to three other common antiepileptic drugs, while children exposed to lamotrigine, carbamazepine or levetiracetam revealed little to no problems. This illustrates the need for systematic follow-up of prenatally exposed children, to support pre-pregnancy counseling and treatment decisions in women of reproductive age.

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“…Women with epilepsy who are using sodium valproate experience many issues regarding PCC ranging from choosing not to have a baby due to failed medication switch to the risk valproate pose to the present pregnancy or chances of unsuccessful change from the medication before pregnancy. Therefore, a recommendation for a clear protocol for these women right from diagnosis was made [10]. A study revealed that improving the quality of the relationship between women with diabetes and the health care provider will enhance uptake of PCC among these women as they value the relationships and communication between them [11].…”

Section: Introductionmentioning

confidence: 99%

Perceptions and Practice of Preconception Care by Healthcare Workers and High-Risk Women in South Africa: A Qualitative Study

Ukoha

Mtshali

2021

Healthcare

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Preconception care is biomedical, behavioural, and social health interventions provided to women and couples before conception. This service is sometimes prioritised for women at high risk for adverse pregnancy outcomes. Evidence revealed that only very few women in Africa with severe chronic conditions receive or seek preconception care advice and assessment for future pregnancy. Thus, this study aimed to explore the perceptions and practice of preconception care by healthcare workers and high-risk women in Kwa-Zulu-Natal, South Africa. This exploratory, descriptive qualitative study utilised individual in-depth interviews to collect data from 24 women at high risk of adverse pregnancy outcomes and five healthcare workers. Thematic analysis was conducted using Nvivo version 12. Five main themes that emerged from the study include participants’ views, patients’ access to information, practices, and perceived benefits of preconception care. The healthcare workers were well acquainted with the preconception care concept, but the women had inconsistent acquaintance. Both groups acknowledge the role preconception care can play in the reduction of maternal and child mortality. A recommendation is made for the healthcare workers to use the ‘One key’ reproductive life plan question as an entry point for the provision of preconception care.

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The preconception care experiences of women with epilepsy on sodium valproate

Abstract: A clear and adequately funded preconception care pathway is needed from epilepsy diagnosis, including support for stress. Understanding what influences maternalisation may help understand uptake of preconception care.

Cited by 13 publications

References 19 publications

Treatment decisions in women of childbearing age on valproate

Treatment decisions in women of childbearing age on valproate

Neurocognition after prenatal levetiracetam, lamotrigine, carbamazepine or valproate exposure

Perceptions and Practice of Preconception Care by Healthcare Workers and High-Risk Women in South Africa: A Qualitative Study

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