Do women with epilepsy benefit from epilepsy specific pre-conception care?

BACKGROUND

To determine how pre-conception care (PCC) influenced the outcome of epilepsy, pregnancy and malformation risk in women with epilepsy (WWE).

METHODS

All primigravida in the Kerala registry of epilepsy and pregnancy (KREP) with the final outcome of pregnancy known who were enrolled prospectively in pre-conception stage (PCC group) or first trimester of pregnancy (PRG group) were included. The two groups were compared for fetal and maternal outcomes including seizure control and complications of pregnancy.

RESULTS

There were 320 (30.4 %) in PCC group and 732 in PRG group. Both groups were comparable for epilepsy classification, maternal birth defects and family history of epilepsy but the PCC group had significantly higher education (48.9 %, p = .027) and employment (22.1 %, p < .001). They had higher usage of folate in pre-pregnancy month (87.5 %, p < .001) and first trimester (96.3 %, p < .001) than PRG group. Fewer women in the PCC group were off AEDs in first trimester (5 % vs 9.3 %, p = .018). Within monotherapy group, use of levetiracetam (10.8 %, p = .017), valproate (34 %, p = .002) in PCC group and carbamazepine (39.1 %, p = .04), phenobarbitone (13.3 %, p = .001) in PRG group was significantly high. More women in PCC group were seizure free during pregnancy (62.8 %, p = .005) than PRG group. Early fetal loss was better captured in PCC (90.6 %,p = .025) than in the PRG. There was no difference in malformation rate between PCC (7.2 %) and PRG groups (6.1 %, p = .3).

CONCLUSION

PCC reduced the risk of seizures during pregnancy and improved the periconceptional use of folate but did not influence the fetal malformation risk.

Pre-pregnancy weight loss in women with obesity requesting removal of their intra-uterine contraceptive device in order to conceive: a pilot study of full meal replacement

Obesity during pregnancy is associated with increased risks of thromboembolism, gestational diabetes, pre-eclampsia, miscarriage, congenital anomaly, macrosomia and stillbirth. The current practice, directed at reducing gestational weight gain, is largely ineffective. The present pilot study was designed to assess the acceptability of a 24-week intensive weight management programme (IWMP; full meal replacement followed by partial meal replacement and weight stabilization) to achieve weight loss for women with obesity requesting removal of their intra-uterine contraceptive device in order to conceive. Twenty six (65%) of eligible participants consented to the IWMP; three received this as routine National Health Service care in the University College Hospital clinic and 14 participated in the study. The commonest reasons for not participating were dislike of milk, anxiety and lack of support from family and friends. Omitting one woman who dropped out because of problems unrelated to the intervention, the completion rate was 46.2%. Including all women who started the programme, mean body mass index decreased significantly (P = 0.005) from 37.8 to 35.3 kg/m² . The median percentage decrease was significantly (P = 0.007) greater for women who completed the study (14.2) compared to those who dropped out (1.2). These results suggest an impressive level of weight loss in about one third of all women offered the IWMP who had to defer what they were seeking (pregnancy) while following a challenging programme that they were not seeking. However, studies of other interventions, such as partial meal replacement or commercial products, which may have higher rates of completion are still required.