7.3.1 The role of preconception counselling for women with epilepsy: A systematic review (279)

Janine Winterbottom, Epilepsy Nurse Specialist, Division of Neurological Science, University of Liverpool, Liverpool, United Kingdom Co authors: Rebecca Smyth, Ann Jacoby & Gus Baker J.B.Winterbottom@liv.ac.uk

Abstract:

Background:

Preconception counselling can be defined as the process of planning and preparation for pregnancy, involving optimizing physical, mental and emotional health ahead of conception (Frey & Files, 2006; Chamberlain, 1986). For women with epilepsy (WWE), this requires an ongoing process of information update and review of management, ensuring that the woman conceives with a minimum of risk factors, fully aware of any risks and benefits of treatment and able to make informed decisions about future pregnancies (Crawford, 2005). The author will present the findings of a Cochrane systematic review of the role of preconception counselling for WWE to reduce adverse pregnancy outcome.

Aims:

To determine the effectiveness of preconception counselling aimed at: • Reducing adverse pregnancy outcomes in WWE and their children. • Increasing the knowledge of WWE. • Increasing intention to plan pregnancy. Methods We systematically reviewed the literature, conforming to methods proposed by the Cochrane Library. Eligible studies included: randomised controlled trials; cluster randomised trials; quasi-experimental studies; prospective cohort studies; and interrupted time series (before and after) studies. Quality criteria were established a priori and submitted as a protocol.

Results:

The search located a wealth of published studies (211), including 51 narrative review articles. Thirty studies were considered potentially relevant, few studies evaluated the effectiveness of preconception counselling to improve pregnancy outcome in the study population, and none met the review objectives or inclusion criteria.

Conclusions:

The results of the review suggest a failure to address this important area of research. Demonstrating that whilst there is widespread support for pre-conception counselling interventions to improve the experience and outcome of pregnancy in WWE, evidence of potential benefits or risks of preventive strategies remains unclear. The review directs future research and identifies the need to establish the role healthcare professionals can play in raising the profile of preconception care for WWE.

Reference:

Chamberlain, G. (1986). ‘Prepregnancy Care’, In Chamberlain, G. & Lumley, J. (eds.) Prepregnancy Care: A Manual for Practice. Chichester: John Wiley & Sons Ltd, pp.1-10
Crawford, P. (2005) ‘Best practice guidelines for the management of women with epilepsy’, Epilepsia, 46 (Suppl 9), pp. 117-24. Frey, K.A. & Files, J.A. (2006) 'Preconception Healthcare: What Women Know and Believe', Maternal & Child Health Journal, 10 (Suppl 1), pp.S73-S77

Source of Funding: UK - Research Charity/Foundation

Amount in Funding: 50,001 - 100,000

Biography:

On completion of my nurse training in 1988, my clinical interests as a community nurse in the children’s disability team in Oldham became focused on the care and management of individuals with epilepsy. In 1995, I became Sapphire Nurse (Epilepsy Nurse Specialist) at The Walton Centre for Neurology and Neurosurgery in Liverpool, establishing the epilepsy nursing team. Developing specialist practitioner skills through the MSc in Clinical Nursing at The University of Liverpool I established the preconception clinic for women with epilepsy in 1999; and later the Joint Epilepsy Obstetric Clinics at the Liverpool Women’s Hospital, and satellite clinics at University Hospital Aintree and Whiston Hospital. Most recently, I became a nurse prescriber to further support the needs of individuals with epilepsy. My academic training began as undergraduate at The University of Manchester, leading to study for MA in Health Care Ethics and Law, focusing my thesis on the ethics of care of women with epilepsy. My research training has been shaped by my clinical interests in the care of women with epilepsy; receiving a fellowship grant from Epilepsy Research UK, my postgraduate thesis aims to explore women with epilepsy’s experience of preparing for pregnancy.