Abstracts

Rationale:
0.3-0.7% of pregnant women have epilepsy, the majority will have uneventful pregnancies and normal births. Some will experience an increase in seizures during pregnancy and which complicate approximately 1% of deliveries in WWE resulting in fetal hypoxia and acidosis. These issues cause great concern and anxiety to WWE during their pregnancy. The primary aim of this study was to evaluate from a patient perspective their views on a newly established epilepsy-pregnancy clinic, identify areas for potential improvement and evaluate patient quality of life during pregnancy. The secondary aim was to evaluate obstetrician views in Ireland to accessing epilepsy expertise for their patients.
Method:
Patients were eligible for recruitment into the study if they had attended the clinic at the Mater Misericordiae University Hospital between December 2019 and June 2020. Demographic data, source of referral and time to review were recorded. Patients were issued with a bespoke clinic evaluation form and were also asked to complete a QOLIE-31, a validated quality of life inventory for people with epilepsy. Consultant obstetricians throughout Ireland were invited to take part in a survey of experiences managing epilepsy in pregnancy. Results91 appointments were issued over a 6 month period with 32 patients referred. The average age was 31 years and average time from referral to review was 5.5 weeks. 11 patients returned the surveys. WWE in pregnancy identified anxieties surrounding the harmful effects of medication, experiencing a seizure during pregnancy and lack of knowledge of the maternity hospital in relation to management of epilepsy in pregnancy. Women expressed reassurance at attending the epilepsy pregnancy clinic and reported that their concerns were addressed. 12 patients returned the QOLIE-31 with a mean total score of 74.  Participants demonstrated the lowest mean scores in assessments of energy and fatigue (mean score = 53). The highest mean score was obtained for measures of social functioning (mean score = 88). Consultant obstetricians (n=34) were surveyed regarding experiences of managing epilepsy in pregnancy and accessing neurology expertise in patient management. 26% of participants were uncomfortable managing a patient with epilepsy in pregnancy. Access to specialist advice was available to 74% of participants. Consultant obstetricians identified hazardous factors including insufficient consultant neurology posts, management of WWE in pregnancy in regional units lacking neurology support, the absence of a joint neurology and obstetric clinics and a lack of integrated care between specialities.
Conclusion:
The main concerns for WWE in pregnancy identified in this study centred around fetal medication exposure and possibility of seizures during pregnancy.  Consultant obstetricians surveyed identified service limitations which have the potential to negatively impact pregnancy particularly in some institutions the lack of a joint obstetric epilepsy clinic which will guide service improvement and development in the future.
Funding:
:n/a