Preconceptual counselling for women with epilepsy – is it happening? A retrospective observational medical records review

Epilepsy in pregnancy is common, but it remains a major risk factor for maternal morbidity and mortality. Over the last decade, neurological causes have remained in the top three indirect causes of maternal death in the UK. National reports, including the recent maternity care bundle, have emphasised the importance of preconceptual counselling to optimise maternal health and reduce complications for epileptic women during pregnancy and postpartum. This study is a retrospective medical record review, examining records of epileptic women of childbearing age, taken from a general practitioner (GP) surgery covering more than 17,000 patients. It aims to assess whether documented preconceptual counselling is taking place for these patients. It was found that, excluding those on a legally required sodium valproate risk record, 93% of the patients did not have documented preconceptual counselling. A recommendation for a set of concise questions for GPs to utilise to normalise pregnancy planning and prompt referrals is proposed.