Preconception counselling for women with epilepsy to reduce adverse pregnancy outcome.
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.


OBJECTIVE
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.


METHODS
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), and electronic databases: MEDLINE (OVID) (1950-February 2008); SCOPUS (1966-March 2008); CINAHL (1982-March 2008); PsyclNFO (1806-March 2008); ASSIA (1987-March 2008).


METHODS
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.


METHODS
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.


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


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.
Winterbottom
Janine B
JB
Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool, UK, L9 7LJ. janine.winterbottom@thewaltoncentre.nhs.uk
Smyth
Rebecca Md
RM
Jacoby
Ann
A
Baker
Gus A
GA
D000927:Anticonvulsants / Q000009:adverse effects; D003376:Counseling; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016742:Preconception Care; D011247:Pregnancy; D011256:Pregnancy Outcome
D000927:Anticonvulsants