Population based, prospective study of the care of women with epilepsy in pregnancy
Guidelines for the management of women with epilepsy are not being followed, according to a study in this week's BMJ.
Researchers in Newcastle upon Tyne interviewed 300 pregnant women with epilepsy during 1997-8 about the care they received, advice given prior to conception and control of their epilepsy. General practice and hospital notes were reviewed after the women had given birth to check advice given and assess pregnancy outcomes. The authors found that most women (61%) were managed by a general practitioner. Control of epilepsy was poor, with more than 70% of women reporting ongoing seizures, and compliance with medication was variable.
Only 38% of women recalled receiving advice prior to conception. However, review of the notes of 25 women who denied having received advice showed that eight had been counselled. Malformations were more common in babies born to mothers with epilepsy, although not all malformations were attributable to anti-epileptic drugs, add the authors.
Most published guidelines are targeted at neurologists, say the authors, and therefore fail to improve the management of women under the care of their general practitioner. Considerable expansion of epilepsy services in primary and secondary care is needed if the guideline recommendations are to be achieved, they conclude.
Contact:
Susan Fairgrieve, Genetic Nurse Specialist, Department of Human Genetics, Royal Victoria Infirmary, Newcastle upon Tyne, UK
Email: JohnBurn@newcastle.ac.uk