Preconception counselling for women with epilepsy to reduce adverse pregnancy outcome

Winterbottom JB, Smyth RMD, Jacoby A, Baker GA

Published Online:

October 7, 2009

No evidence to support preconception counselling for women with epilepsy.

The majority of women with epilepsy will experience a normal pregnancy and delivery; however, this requires informed decisions by women, balancing the risk to the fetus against the need to maintain seizure control during their reproductive years. The review did not find any evaluations of preconception counselling and educational interventions that were of sufficient quality to be included in the systematic review. There was not enough evidence to reach a conclusion about the effect of counselling and educational interventions to improve pregnancy outcome for women with epilepsy preparing for pregnancy.

Abstract (click to read)

Background:

The provision of preconception counselling to women with epilepsy (WWE) has become established as recommended practice and includes a review of drug treatment and the provision of information and advice on both seizure and treatment-related risks to both mother and child. In this review we assess the evidence regarding the effectiveness of preconception counselling for WWE.

Objectives:

To determine the effectiveness of preconception counselling for WWE, measured by a reduction in adverse pregnancy outcome in both mother and child; increased knowledge of preconception issues in WWE and increasing intention to plan pregnancy.

Search strategy:

We searched the Epilepsy Group's Specialized Register (30/01/2008), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 4), MEDLINE (OVID) (1950-February 2008), SCOPUS (1966-March 2008), CINAHL (1982-March 2008), PsyclNFO (1806-March 2008), and ASSIA (1987-March 2008).

Selection criteria:

Randomised control trials; including cluster and quasi-randomised trials, prospective cohorts, controlled before and after studies, and interrupted time series that compared the outcomes in mothers with epilepsy and infants of mothers with epilepsy who received preconception counselling, to the outcomes of mothers with epilepsy and their infants who received standard care or no intervention.

Data collection and analysis:

The methodological quality of potentially relevant studies were assessed to determine appropriate inclusion. Where necessary, study authors were contacted for additional information. No studies met the review inclusion criteria.

Main results:

The search strategy identified 11 studies for consideration of inclusion. However, none met the required criteria for inclusion.

Authors' conclusions:

There is no evidence to inform the content, methods of delivery or effectiveness of preconception counselling to improve pregnancy outcomes for WWE and their offspring. The value of counselling delivered to WWE prior to conception, with the intention of reducing the risks of adverse outcome in mother and child, requires evaluation in well-designed studies, appropriately powered to detect changes in both maternal and infant outcome.

This record should be cited as:

Winterbottom JB, Smyth RMD, Jacoby A, Baker GA. Preconception counselling for women with epilepsy to reduce adverse pregnancy outcome. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006645. DOI: 10.1002/14651858.CD006645.pub2

Assessed as up to date:

January 30, 2008

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Primary Review Group:

Epilepsy Group

Health topics:

Neurology > Epilepsy > Psychosocial interventions

Pregnancy & childbirth > Basic care during pregancy

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Preconception counselling for women with epilepsy to reduce adverse pregnancy outcome

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