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Smith Malm C, Klecki J, Lisovska K, Zelano J. Survey of an online system for information to women with epilepsy of childbearing age and management during pregnancy: A 3-year evaluation. Epilepsia Open 2024; 9:558-567. [PMID: 38135910 PMCID: PMC10984308 DOI: 10.1002/epi4.12893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 11/16/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE We developed an online tool for women with epilepsy consisting of two modules: one with information on pregnancy-related issues (information module) and one for reminders about blood test and communication about dose changes (pregnancy module). Our aim was to assess perceived value, user-friendliness and improvement of patient knowledge in users. METHODS The system was launched in 2019 and patients invited by epilepsy nurses were asked to participate in a survey 1 month after the invitation for the information module, and 1 month postnatally for the pregnancy module. RESULTS By November 2022, the system had been used by 96 individuals out of 100 invited in the pregnancy module, in a total of 114 pregnancies. One hundred and eleven women had been invited to the information module, and 70 of these accessed it. The survey received 96 answers (44 information, 52 pregnancy). User-friendliness was rated as good or very good by a little over half of the users; 55% in the information module and 52% in the pregnancy module. Among pregnant women, 83% found the TDM part useful and most would prefer a similar system in future pregnancies. Sixty-four percent of users of the information module and 48% of the pregnancy module found that the system had increased their knowledge. Two knowledge questions were answered correctly by a significantly higher proportion of those that had accessed the online information. SIGNIFICANCE There was great demand for online communication during pregnancy and our experiences of implementation can hopefully assist digitalization of epilepsy care elsewhere. Online information also seems to increase knowledge about pregnancy-related issues, but our invitation-only method of inclusion was not effective for widespread dissemination. Patient-initiated access with optional epilepsy-team contact if questions arise could be an alternative. PLAIN LANGUAGE SUMMARY We have performed a survey of users of a new Internet-based tool for information to women of childbearing age and communication about dose changes during pregnancy. Users were overall satisfied with the tool and answered some knowledge questions more accurately after accessing the information.
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Affiliation(s)
| | - Judith Klecki
- Department of NeurologySahlgrenska university hospitalGothenburgSweden
| | - Kristina Lisovska
- Department of NeurologySahlgrenska university hospitalGothenburgSweden
| | - Johan Zelano
- Department of NeurologySahlgrenska university hospitalGothenburgSweden
- Institute of neuroscience and physiology, Department of clinical neuroscience, Sahlgrenska AcademyGothenburg UniversityGothenburgSweden
- Wallenberg Center of Molecular and Translational MedicineGothenburg UniversityGothenburgSweden
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Manouchehri E, Larki M, Sahebari M. Exploring the understanding and experience of women with rheumatic diseases regarding fertility intention- a qualitative content analysis. BMC Womens Health 2024; 24:124. [PMID: 38365703 PMCID: PMC10874060 DOI: 10.1186/s12905-024-02969-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 02/12/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Patients with rheumatic diseases (RDs) have a lower desire to have children, fewer children, and a longer interval between their pregnancies, which can be due to the patient's personal choice, the physician's advice, changes in sexual activity, changes in fertility, and pregnancy failure. This study aimed to explore the understanding and experience of women with RDs regarding pregnancy intention. METHOD In Mashhad, Northeast Iran, between December 2022 and March 2023, this qualitative inquiry was carried out. Purposive sampling was used to select thirty women with RDs. Semi-structured interviews were used to collect the data. Graneheim and Lundman's conventional content analysis method was used to analyze the data. The data organization was done using MAXQDA 12 software. Credibility, dependability, confirmability, and transferability have been considered as elements of trustworthiness. RESULTS The participants' data analysis revealed the following main theme: "duality of desire and fear in childbearing". Five main categories were identified, including "Individual health concerns following pregnancy", "motherhood and womanhood perceptions", "concerns about child harm", "contradictory beliefs and attitudes of significant family members and clinicians about pregnancy", and "lack of social support for fertility". CONCLUSION In order to improve the outcomes of pregnancy for women with RDs, the medical professionals who manage them must actively and frequently inquire about their intentions to childbearing and offer them individualized guidance on how to be in the best possible health at the time of conception. Rheumatologists, gynecologists, and reproductive health specialists can better address the sexual and reproductive health needs of this population by enhancing their collaboration in the care of women with RDs.
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Affiliation(s)
- Elham Manouchehri
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Midwifery, Faculty of Nursing and Midwifery, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
| | - Mona Larki
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Sahebari
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Li Q, Cao Y, Zhang J, Fu Y, Shen B, Wang S, Fang J. Pregnancy-related knowledge in women with epilepsy in childbearing age: A pilot questionnaire survey from China. Brain Behav 2024; 14:e3400. [PMID: 38340294 PMCID: PMC10858722 DOI: 10.1002/brb3.3400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 02/12/2024] Open
Abstract
PURPOSE We aim to understand the knowledge of and attitudes toward pregnancy issues among women with epilepsy (WWE) and their caregivers and analyze the answers from the questionnaire to expose topics that require educational activities; thus, WWE experiences pregnancy better. METHODS WWE at their childbearing age and/or their caregivers who entered the Fourth Affiliated Hospital of Zhejiang University for treatment of their condition were invited to fill out a questionnaire between March 1 and November 31, 2022. RESULTS A combined total of 205 WWE and 142 caregivers completed the questionnaires. Among the surveyed WWE, a majority (63.74%) reported experiencing at least one miscarriage or induced abortion. However, a significant proportion (84.62%) of these WWE were still able to successfully give birth to at least one child. Furthermore, the offspring of these WWE showed no significant differences compared to the offspring of women without epilepsy, as reported by 93.51% of the participants. The participants' knowledge regarding the impact of epilepsy on pregnancy was found to be comparable, with average scores of 7.74 and 7.84, respectively. The participants exhibited a limited comprehension of antiseizure medications (ASMs)-related knowledge, specifically pertaining to ASMs adjustment during pregnancy (17.56% vs. 16.90%) and offspring outcomes (30.24% vs. 26.06%). Statistical analysis revealed significant correlations between the overall score and education level (p < .001), as well as epilepsy duration (p = .008). Regarding the source of knowledge, participants acknowledged primarily relying on neurologists, who remained their preferred choice for consultation. CONCLUSION In our study, the understanding of pregnancy-related knowledge did not differ from WWE and their caregivers, both are far from satisfactory in certain areas. It is urgent for WWE and their caregivers to improve their pregnancy-related knowledge of epilepsy. As their primary access is from knowledgeable health care professionals like neurologists, well-trained neurologists in epilepsy management during pregnancy are in need.
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Affiliation(s)
- Qiwei Li
- Department of Neurology, The Fourth Affiliated Hospital, International Institutes of MedicineZhejiang University School of MedicineYiwuP. R. China
| | - Yina Cao
- Department of Neurology, The Fourth Affiliated Hospital, International Institutes of MedicineZhejiang University School of MedicineYiwuP. R. China
| | - Jingxin Zhang
- Department of Neurology, The Fourth Affiliated Hospital, International Institutes of MedicineZhejiang University School of MedicineYiwuP. R. China
| | - Yanlu Fu
- Department of Neurology, The Fourth Affiliated Hospital, International Institutes of MedicineZhejiang University School of MedicineYiwuP. R. China
| | - Beibei Shen
- Department of Neurology, The Fourth Affiliated Hospital, International Institutes of MedicineZhejiang University School of MedicineYiwuP. R. China
| | - Shuang Wang
- Department of Neurology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouZhejiangP. R. China
| | - Jiajia Fang
- Department of Neurology, The Fourth Affiliated Hospital, International Institutes of MedicineZhejiang University School of MedicineYiwuP. R. China
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Lo CB, Conrad B, Debs A, Herbst J, Kulkarni N, Nelson DM, Wentzel E, Cohen DM, Patel AD. Counseling on the Need for Folic Acid in Adolescents With Epilepsy. Neurol Clin Pract 2023; 13:e200177. [PMID: 37529297 PMCID: PMC10389172 DOI: 10.1212/cpj.0000000000200177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/09/2023] [Indexed: 08/03/2023]
Abstract
Background and Objectives Folic acid is an important supplement to take for women with epilepsy on antiseizure medications (ASMs). Determination of baseline counseling given to women with epilepsy and the association with folic acid being recommended were evaluated. Factors surrounding the association were reviewed. Methods An exploratory retrospective review of women with epilepsy seen at a large Midwestern pediatric institution was performed between January 2018 and January 2020. Results Patients who received preconception counseling were more likely to be given a recommendation to take folic acid. Patients on more than 1 ASM were likely to receive counseling. Patient age and race were associated with having folic acid recommended. Discussion Providing preconception counseling for women with epilepsy is associated with an increased recommendation and prescription of folic acid. Further evaluation into possible disparities to receiving a folic acid recommendation is needed.
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Affiliation(s)
- Charmaine B Lo
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - Bailey Conrad
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - Andrea Debs
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - James Herbst
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - Neil Kulkarni
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - Dustin Mark Nelson
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - Evelynne Wentzel
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - Daniel M Cohen
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
| | - Anup D Patel
- Division of Emergency Medicine (CBL, DMN, DMC), Nationwide Children's Hospital; Pediatric Emergency Medicine (CBL), Abigail Wexner Research Institute at Nationwide Children's Hospital; The Ohio State University College of Medicine (BC); Division of Neurology (AD, NK, EW, ADP), Nationwide Children's Hospital; Endocrinology and Metabolism Institute (AD), Cleveland Clinic; Department of Pharmacy (JH), Nationwide Children's Hospital, Columbus, OH; Lincoln Memorial University (DMN), Debusk College of Osteopathic Medicine, Knoxville, TN; Department of Pediatrics (DMC, ADP), The Ohio State University College of Medicine; and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH
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Morbidity and rehospitalization postpartum among women with epilepsy and their infants: A population-based study. Epilepsy Behav 2022; 136:108943. [PMID: 36252288 DOI: 10.1016/j.yebeh.2022.108943] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/15/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We compared the relative occurrence of selected pregnancy outcomes and postpartum rehospitalizations among women with and without epilepsy and their infants. Using linked vital-hospital discharge records of women with deliveries in Washington State 1987-2014, comparisons were made overall, by epilepsy type, and by time periods related to antiepileptic drug (AED) marketing changes. METHODS This population-based retrospective cohort study identified women with, and without epilepsy per diagnosis codes in the hospital discharge record from among all deliveries during 1987-2014 to examine maternal and infant outcomes, rehospitalization and mortality <2 years postpartum. Relative risks (RRs) and 95 % confidence intervals (CI) overall, and by epilepsy type were calculated using Poisson regression. We assessed the validity of epilepsy identification based on diagnosis codes by conducting a medical chart review for a sample of women. RESULTS Women with epilepsy had increased risks of preeclampsia (RR 1.23; 95 % CI 1.08-1.41) and gestational diabetes (RR 1.18; 95 % CI 1.02-1.36). Their infants had increased malformation (RR 1.23; 95 % C: 1.08-1.42) and small for gestational age (SGA, RR 1.39; 95 % CI 1.25-1.54) risks, and were nearly three times as likely to not be breastfed. Affected mothers (RR 5.25; 95 % CI 2.46-11.23) and their infants (RR 1.64, 95 % CI 1.41-1.89) required more ICU admissions during the delivery hospitalizations, and more postpartum rehospitalization, with greatest risk in the first six months. Maternal mortality < 2 years after delivery was increased (RR 7.11; 95 % CI 2.47-20.49). Increased risks were observed for all epilepsy subtypes for nearly all outcomes examined. Risks of preterm delivery and low birthweight increased over time (p <.05). Suggestive, but not statistically significant temporal decreases in risks of gestational diabetes and malformations and increased risk of preterm labor were noted. We observed high sensitivity of diagnosis codes for identifying pregnant women with epilepsy. CONCLUSION These population-based results emphasize the need for frequent postpartum monitoring of women with epilepsy. Increases in risks of low birthweight and preterm delivery over time are of concern. Possible temporal changes in other outcomes warrant further investigation.
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Persistent knowledge gaps between 2005 and 2020 in women with epilepsy: Comparison of multicenter studies from Germany. Seizure 2022; 100:36-43. [PMID: 35749829 DOI: 10.1016/j.seizure.2022.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/01/2022] [Accepted: 06/12/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Epilepsy is a chronic condition that can affect patients of all ages. Women with epilepsy (WWE) require access to specific counseling and information regarding issues related to contraception, pregnancy, and hormonal effects on seizure control and bone mineral density. This study investigated the knowledge among WWE regarding their condition, and whether epilepsy-specific knowledge has improved over the last 15 years. METHODS A total of 280 WWE aged 18 to 82 years participated in this multicenter, questionnaire-based study. The study was conducted at four epilepsy centers in Germany, between October 2020 and December 2020. Sociodemographic and epilepsy-specific data for participating women were analyzed and compared with the results of a similar survey performed in 2003-2005 among 365 WWE in Germany. RESULTS The questionnaire-based survey revealed considerable knowledge deficits without significant improvements over the last 15 years, particularly among those with less education and with regards to information on the more pronounced effects of epilepsy in older WWE (>50 years), including interactions with menopause and osteoporosis. In WWE ≤29 years, a significant increase in the knowledge score was observed in 2020 compared with this age group in 2005 (mean 7.42 vs. 6.5, p = .036). Mothers frequently reported epilepsy-related concerns regarding childrearing, particularly of seizures scaring their child and the need to rely on other people. CONCLUSION WWE continue to demonstrate inadequate epilepsy-related knowledge. Despite increasing information availability and the aspiration toward better awareness among medical professionals, overall knowledge has not increased sufficiently compared with the levels observed in recent studies.
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Hammarberg K, Stocker R, Romero L, Fisher J. Pregnancy planning health information and service needs of women with chronic non-communicable conditions: a systematic review and narrative synthesis. BMC Pregnancy Childbirth 2022; 22:236. [PMID: 35317730 PMCID: PMC8941766 DOI: 10.1186/s12884-022-04498-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/11/2022] [Indexed: 12/18/2022] Open
Abstract
Background Preparing for pregnancy and being in the best possible health before conception improves reproductive outcomes. For women living with a chronic non-communicable disease (NCD), pregnancy planning is essential to allow optimal disease control in preparation for pregnancy. Aim The aim was to review the literature relating to the pregnancy planning health information and service needs of women with NCDs. Method The MEDLINE (Ovid), Embase (Ovid), Emcare (Ovid), PsycINFO (Ovid), CINAHL and Scopus databases were searched. Studies were included if they were published in peer-reviewed English language journals between January 2010 and June 2020 and reported on the pregnancy planning health information and service needs of women with rheumatic diseases, asthma, cystic fibrosis, depression and/or anxiety, type 1 diabetes mellitus, epilepsy, or multiple sclerosis. Risk of bias was assessed using QualSyst. The characteristics of the studies were tabulated and summarised. Key findings of the included studies were analysed thematically using an inductive approach, where the study findings determined the themes. Findings are reported in a narrative synthesis. Results The database searches yielded 8291 results, of which 4304 remained after duplicates were removed. After abstract screening 104 full-text papers were reviewed. Of these 15 met inclusion criteria and were included in analysis. The narrative synthesis of the included studies revealed six themes: ‘Women with chronic conditions have unmet preconception health information needs’, ‘Women with chronic conditions want personalised preconception health information’, ‘Preferred sources of preconception health information’, ‘Learning from the experiences of other women’, ‘Improving preconception health discussions with health care professionals’, and ‘Women want holistic care’. These themes were consistent across all studies, highlighting the similarity of experiences and needs of women with different chronic conditions. Conclusion To improve pregnancy outcomes for women living with NCDs, health care providers need to ask women of reproductive age proactively and routinely about their pregnancy intentions and provide them with personalised advice on how to avoid unplanned pregnancy and be in optimal health when they wish to conceive. PROSPERO registration number CRD42020176308. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04498-1.
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Affiliation(s)
- Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Ruby Stocker
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lorena Romero
- The Ian Potter Library, The Alfred, Melbourne, Australia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Murphy OC, Wrigley S, Walsh RA, Freir DB, McCarthy AJ, O'Dowd S, McCabe DJH. Assessment of the adequacy of counselling regarding reproductive-related issues in women of childbearing age on anti-epileptic drugs. QJM 2021; 114:233-237. [PMID: 32298454 DOI: 10.1093/qjmed/hcaa131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/10/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The use of anti-epileptic drugs (AEDs) in women of childbearing age (WCBA) necessitates careful counselling regarding reproductive-related issues. AIM (i) To compare documentation of appropriate counselling regarding reproductive-related issues in WCBA prescribed AEDs for non-epilepsy vs. epilepsy indications, and (ii) to examine whether the frequency of counselling improved after introduction of 'standardized typed advice'. DESIGN Retrospective audit and quality assessment and improvement programme. METHODS We analysed medical records of all WCBA prescribed gabapentin, pregabalin, topiramate, valproate or carbamazepine by a general neurology clinical service before (Study period A) and after (Study period B) introduction of standardized typed passages regarding potential teratogenicity ± interactions with hormonal contraception at a university teaching hospital. The χ2 test or the Fisher's exact test was employed, as appropriate. RESULTS In WCBA prescribed AEDs for non-epilepsy indications, documentation of appropriate counselling regarding potential teratogenicity improved from 49% (17/35 patients) in Period A to 79% (27/34 patients) in Period B (P = 0.008). The frequency of counselling regarding teratogenicity was higher in patients prescribed AEDs for epilepsy compared with non-epilepsy indications in Study period A (100% vs. 49%, P = 0.002), but was no longer significantly different in Study period B (86% vs. 79%, P = 0.64). Documentation of counselling regarding potential interaction of enzyme-inducing AEDs with hormonal contraception did not significantly change between study periods. CONCLUSION Significant improvements in documentation regarding potential teratogenicity of AEDs prescribed for non-epilepsy indications can be achieved by introducing standardized, typed passages copied to patients. Such a practice change is practical and widely applicable to neurological and non-neurological practice worldwide.
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Affiliation(s)
- O C Murphy
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH) / Tallaght University Hospital, Dublin D24 NR0A, Ireland
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - S Wrigley
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH) / Tallaght University Hospital, Dublin D24 NR0A, Ireland
| | - R A Walsh
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH) / Tallaght University Hospital, Dublin D24 NR0A, Ireland
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - D B Freir
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH) / Tallaght University Hospital, Dublin D24 NR0A, Ireland
| | - A J McCarthy
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH) / Tallaght University Hospital, Dublin D24 NR0A, Ireland
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH) / Tallaght University Hospital, Dublin, D24 NR0A, Ireland
| | - S O'Dowd
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH) / Tallaght University Hospital, Dublin D24 NR0A, Ireland
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH) / Tallaght University Hospital, Dublin, D24 NR0A, Ireland
| | - D J H McCabe
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH) / Tallaght University Hospital, Dublin D24 NR0A, Ireland
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH) / Tallaght University Hospital, Dublin, D24 NR0A, Ireland
- Department of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, UK
- Vascular Neurology Research Foundation, C/O Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH) / Tallaght University Hospital, Dublin D24 NR0A, Ireland
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Lisovska K, Gustafsson E, Klecki J, Edelvik Tranberg A, Zelano J. An online tool for information to women with epilepsy and therapeutic drug monitoring in pregnancy: Design and pilot study. Epilepsia Open 2021; 6:339-344. [PMID: 34033254 PMCID: PMC8166785 DOI: 10.1002/epi4.12473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Information to women with epilepsy on pregnancy-related antiseizure medication (ASM) issues and reliable tools for therapeutic drug monitoring (TDM) are important aspects of epilepsy care. We aimed to develop and test an online tool for patient education on pregnancy-related issues and communication with epilepsy nurses during pregnancy for women with epilepsy. METHODS An existing national platform for online communication (1177.se) was used, and an online tool was developed by two epilepsy nurses, two neurologists, and an IT technician. The tool was launched as a complement to standard care, and patients deciding to use it were invited to participate in a survey of user experiences and knowledge questions. RESULTS The online tool consists of two modules: one for patient education and one for TDM during pregnancy. The latter module allows scheduling of automatic reminders of blood tests that are sent to patients at set intervals. The epilepsy nurse can communicate results and suggested dose changes in the tool. A total of 48 women answered the survey: 28 had been invited to use the information module and 20 to use the TDM module. Patient experiences were generally good, and most users of the TDM module would prefer an online means of communication in future pregnancies. For epilepsy nurses, the tool provided good overview of patients currently pregnant and administrative advantages compared with traditional means of communication. SIGNIFICANCE Online patient education and communication about TDM during pregnancy are feasible and can be a valuable part of future digitalization efforts in epilepsy care.
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Affiliation(s)
- Kristina Lisovska
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Gustafsson
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Judith Klecki
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Edelvik Tranberg
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Johan Zelano
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Gothenburg, Sweden
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10
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Egawa M, Hara K, Ikeda M, Kono E, Miyashita S, Miyasaka N, Inaji M, Maehara T, Yoshida M. Role of obstetricians in promoting pregnancy-related knowledge among women with epilepsy in Japan. Epilepsy Behav 2020; 111:107176. [PMID: 32599429 DOI: 10.1016/j.yebeh.2020.107176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 11/16/2022]
Abstract
The importance of informing women with epilepsy (WWE) of pregnancy-related issues when they are of reproductive age is well recognized. However, in Japan, education on pregnancy-related issues for these patients is insufficient. Obstetricians encounter patients who have self-discontinued their medications upon realizing they are pregnant. In this study, we aimed to assess the needs and understand knowledge levels regarding pregnancy-related issues among Japanese WWE. We contacted 400 board-certified epileptologists and asked them to administer our questionnaire to their patients; 51 responses were analyzed. Among all participating WWE, 100% were taking medication at the time of the study, 34% had given birth, and 63% expressed a desire to have children in the near future. Additionally, the median questionnaire score on pregnancy-related matters was as low as 9.5 out of 13 points. Only 31% of WWE knew that the mode of delivery is not always cesarean delivery. Among WWE, 62.7% stated that they had received counseling about pregnancy-related matters. Opinions differed regarding the optimum timing for counseling according to whether patients had received counseling. As for topics WWE wished to have explained to them, inheritance of epilepsy by their children ranked highly. The average satisfaction level with counseling was 5.6 of 7 points. Regarding satisfaction with counseling, there was a significant difference between WWE who expressed a desire to receive information from obstetricians and those who did not. In summary, we believe that our study shows that Japanese WWE remain ill-informed about pregnancy-related issues and that existing counseling must be revised. Obstetricians must play a role in preconception counseling.
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Affiliation(s)
- Makiko Egawa
- Department of Nutrition and Metabolism in Cardiovascular Disease, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.
| | - Keiko Hara
- Department of Respiratory and Nervous System Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan; Hara Clinic, Yokohama, Japan
| | - Masami Ikeda
- Faculty of Education and Humanities, Department of Psychology, Jumonji University, Japan
| | - Eri Kono
- Comprehensive Reproductive Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Susumu Miyashita
- Division of Maternal and Fetal Medicine, Perinatal Medicine Center, Dokkyo Medical University, Japan
| | - Naoyuki Miyasaka
- Comprehensive Reproductive Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Japan
| | - Masayuki Yoshida
- Department of Life Science and Bioethics, Graduate School of Medicine, Tokyo Medical and Dental University, Japan
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11
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Knowledge of pregnancy and procreation in women with epilepsy of childbearing age: A 16-year comparative study in Poland. Epilepsy Res 2020; 164:106372. [PMID: 32480232 DOI: 10.1016/j.eplepsyres.2020.106372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 11/23/2022]
Abstract
Studies across countries and time periods have demonstrated insufficient pregnancy-related knowledge in women with epilepsy (WWE) of childbearing age. To assess the current state of such knowledge as well as the relevant time-related changes over 16 years in Poland, we conducted a study of WWE using a questionnaire developed in 2003. The participants were 656 WWE of childbearing age who completed online and paper-based questionnaires. The results were compared with those obtained in 2003. Overall, pregnancy-related knowledge improved significantly over 16 years. This improved knowledge was most evident in preconception use of folic acid and breastfeeding. However, even now, less than 40% of WWE believe that breastfeeding is possible in most cases. In 2019, pregnancy-related knowledge was positively correlated with participants' educational level and hometown size and negatively correlated with the frequency of generalized tonic-clonic seizures. Women completing the online survey had better knowledge than those who completed the paper-based survey. Indications for cesarean section, the possibility of using oral contraception and breastfeeding are the areas where knowledge in WWE remains inadequate, necessitating targeted educational activities.
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12
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Harris L, Lowes O, Angus‐Leppan H. Treatment decisions in women of childbearing age on valproate. Acta Neurol Scand 2020; 141:287-293. [PMID: 31883101 DOI: 10.1111/ane.13211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There are little data on the understanding and participation of women of childbearing age in decisions about their choice of antiepileptic drugs (AEDs). Valproate carries a risk of major congenital malformations, developmental and behavioural delay. For some, valproate is the only medication to prevent potentially life-threatening seizures. MATERIALS & METHODS This was a cross-sectional study of two groups of women of childbearing age; 50 taking valproate and 50 controls. Each patient completed a patient questionnaire and structured telephone interview assessing understanding of the risks and benefits of AEDs in relation to pregnancy. Analysis used unpaired two-tailed t test and chi-squared test, with Bonferroni correction. Follow-up at 12 months showed that 8% of the women taking valproate had switched to other medication. RESULTS Hundred patients participated in the study, 89 on AEDs for epilepsy, 4 for migraine, and 7 for both. 55% of participants stated they were not involved in decision-making. More patients in the valproate group were informed about (64% vs 42%, P < .005), and expressed understanding of (64%vs 32%, P < .001), the risks involved with treatment. 59% of all patients wanted more information. The minority of women surveyed took folic acid (37%) or used contraceptives (29%). Valproate was used following failure of other AEDs to control seizures in 80%. DISCUSSION This in-depth survey suggests more information is needed for women taking AEDs, using a range of formats. Women taking valproate are better informed than those on levetiracetam or lamotrigine. Information provision on the use of folic acid and contraception needs improvement.
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Affiliation(s)
| | - Olivia Lowes
- University Hospital Coventry and Warwickshire Coventry UK
| | - Heather Angus‐Leppan
- Clinical Neurosciences Royal Free London NHS Foundation Trust University College London London UK
- Institute of Neurology University College London London UK
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13
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Prenatal valproate in rodents as a tool to understand the neural underpinnings of social dysfunctions in autism spectrum disorder. Neuropharmacology 2019; 159:107477. [DOI: 10.1016/j.neuropharm.2018.12.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/11/2018] [Accepted: 12/20/2018] [Indexed: 12/22/2022]
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Elnaeim AK, Elnaeim MK, Babiker IBA. Knowledge of women issues and epilepsy among doctors in Sudan. Epilepsy Behav 2018; 84:79-82. [PMID: 29754108 DOI: 10.1016/j.yebeh.2018.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to assess the knowledge of doctors in Sudan about women issues related to epilepsy. METHODS In this cross-sectional study that was conducted in Sudan during the period from October 2017 to December 2017, we used Google forms to collect data from 154 doctors using Knowledge of Women Issues and Epilepsy (KOWIE) II standardized questionnaire. RESULTS Our studied group included house officers (n = 34), medical officers (n = 60), registrars (n = 52), and specialists (n = 8). The majority of participants were aware of the role of folic acid in reducing teratogenicity of antiepileptic drugs (AEDs) (89%) and that women with epilepsy (WWE) should not stop taking their AEDs during pregnancy (76.6%). Two-thirds of participants knew that most WWE have healthy children (68.2%) and that enzyme-inducing AEDs may reduce effectiveness of some contraceptives (72.1%). Half of participants were aware of the association between AEDs and osteomalacia (50%), and more than one-third (38.3%) knew that women taking AEDs can safely breastfeed (38.3%). Few of them (20.1%) knew that WWE have a higher incidence of sexual dysfunction compared with women without epilepsy, and only some (15.6%) knew that estrogen has a proconvulsant effect while progesterone has anticonvulsant qualities. The mean score of our participants was 5.53 out of 10 (standard deviation (SD) ± 1.64). Only registrars with the highest mean knowledge (6.15 ± 1.26) were statistically different from the rest of the medical degree groups. CONCLUSIONS In this small cross-sectional study, Sudanese doctors' knowledge was not satisfactory regarding the majority of questions on KOWIE II. Further education and training are indicated to decrease this knowledge gap and to improve care of WWE.
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Affiliation(s)
- Awab K Elnaeim
- Daoud Research Group, Sudan; University of Medical Sciences and Technology, Sudan
| | | | - Ismat B A Babiker
- Daoud Research Group, Sudan; University of Medical Sciences and Technology, Sudan.
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