Pre-Pregnancy Counselling

Question 1

What are the foetal and maternal risks of epilepsy during pregnancy?

Answer 1

• Maternal risks – increased maternal mortality, and most other pregnancy-related complications are a little higher
• Foetal risks – hypoxia during tonic-clonic seizures
• Heritability – about 9% children of affected mothers will have some seizure before 25

Question 2

With regards to maternal epilepsy, what strategies should be utilised to prevent complications?

Answer 2

• Minimising stressors – sleep deprivation, stress
• Anti-seizure medication – usual medication should be the one used, at the lowest possible dose
  
  • Valproate is an exception; try to control with other drugs
• Foetal anomalies – folic acid supplementation (0.4-0.8 daily) - more with carbamazepine/valproate (4mg), vitamin K supplementation in the last month

Question 3

What anti-epileptic drugs haev an effect on contraception?

Answer 3

• Contraception – P450 inducers e.g. carbamazepine, phenytoin, topiramate can cause contraceptive failure
• Consider higher doses or locally acting/barrier methods

Question 4

Outline the general pre-pregnancy counselling considerations you might have for a woman with epilepsy

Answer 4

• Counsel: risks (slightly increased), reassurance (most are uncomplicated), medication compliance (very important)
• Medication changes: folate (more), antiepileptic dose (minimum) and type (not phenytoin or >1), contraception (more)

Question 5

Outline the general pre-pregnancy counselling considerations you might have for a woman with type 1 diabetes

Answer 5

• Risks
  
  • Maternal (miscarriage 3x, preeclampsia 3-4x, polyhydramnios, preterm delivery, LUSCS, worsening of microvascular disease, DKA)
  • Foetal (congenital anomalies 2x, preterm birth, macrosomia, mortality, poor long-term outcomes more likely)
• Prevention
  
  • Glycaemic control <6-6.5 pre-conception, CV risk factor optimisation
  • Folate (5mg)
• Insulin - higher doses required during pregnancy