8. Evaluation of counselling received by women with epilepsy in their reproductive years and management in pregnancy

Objective The primary outcome of the study was to evaluate whether women with epilepsy (WWE) of reproductive age received counselling before conception, including issues such as folate supplementation, antiepileptic drug selection (AED) and their potential teratogenic risks. Background WWE of reproductive age should be counselled regarding their condition and the potential complications of pregnancy associated with epilepsy and AEDs, considering that 50% of pregnancies are unplanned. Design/methods We retrospectively reviewed 64 consecutive medical charts of WWE between the ages of 13 and 50, who were followed prior to conception, and managed during pregnancy at the Centre Hospitalier Universitaire de Sherbrooke (CHUS) between July 1, 2003 to June 30, 2013. Twenty patients were excluded primarily due to referral to the CHUS only after conception. Forty-two patients, encompassing 62 pregnancies were included. Maternal and neonatal charts were thoroughly reviewed and information was collected on an Excel spreadsheet. The protocol was approved by the Ethics review Board of the CHUS. We described our population regarding pre-conception counselling, dose of folate supplementation taken, type, dose and quantity of AEDs, control of seizure in the year preceding pregnancy as well as throughout pregnancy, maternal and neonatal complications or malformations. We evaluated whether those who received counselling before pregnancy were less likely to be taking Valproic acid (VPA) during pregnancy, have less seizures during pregnancy and less complications during pregnancy and delivery. Results Counselling before conception was documented in 45/62 (72.6%) of medical charts. Folate supplementation before pregnancy was prescribed in 44/62 (71%) pregnancies. Risks of complications were formally documented in 27/62 (43%) of charts. There were no statistically significant differences between those receiving counselling and those that did not, in terms of seizure frequency during pregnancy, and VPA use. Interestingly, of the 15 (100%) women on an AED polytherapy, all received counselling compared to those who did not ( p = 0.006). There were no statistically significant differences regarding maternal and neonatal complications for women on polytherapy, those on VPA or women with seizure during pregnancy, compared to their counterparts. Two cases of malformations were detected and one woman died unexpectedly at 18 weeks of pregnancy. Between 2003 and 2008 there were 11/34 (32%) women on VPA compared to 2/26 (7%) between 2009 and 2013, p = 0.026. Conclusion This study has shown that the rate of counselling received by WWE at our centre was satisfactory, but remains an area that can be improved. Physicians should more actively be prescribing folate supplementation to this population due to the high rate of unexpected pregnancies. More attention should be placed in formally documenting important discussions about risks of epilepsy and AED. We plan to raise awareness of these issues to the healthcare professionals at our center who are involved in the care of WWE during their reproductive years.