Pro-active pre-conception counselling in epilepsy— is it effective?

Development of epilepsy services in the northern region has included a baseline audit of the availability of pre-conceptual advice, AED prescribing, folic acid usage, vitamin K administration and pregnancy outcome in women with epilepsy which we now report. Patients, identified by community midwives, complete a standardized interview questionnaire with a research nurse. Delivery outcome is recorded using obstetric notes. 333 notifications have been received in 18 months, 247 questionnaires and 150 outcome forms completed. Forty-six women requested no contact, 63% receive epilepsy care from their GP, only 35% recalled pre-conceptual advice, and 12% took polytherapy. Of those on monotherapy 50% take carbamazepine, 39% sodium valproate, 9% phenytoin and 1% lamotrigine. Folic acid was taken pre-conceptually by 28% and during pregnancy by 87%. Only 36% took 5 mg folic acid. Vitamin K was given to 72% babies, 38% by intramuscular injection. Adverse outcomes include a baby with phocomelia and a pregnancy terminated for spina bifida in mothers taking valproate. A baby with short ribs was born to a mother on valproate and lamotrigine.