Counselling preconcezionale, programmazione della gravidanza, salute materno-fetale e allattamento nelle donne con epilessia. L'esperienza di un centro di terzo livello

We aimed at assessing pregnancy counseling, pregnancy planning and pregnancy outcome in women with epilepsy taking antiepileptic drugs (AEDs) and followed at our epilepsy centre. We studied concluded pregnancies by women followed at our centre, enrolled in the EURAP registry of AEDs in pregnancy from 2000 to 2011, using the EURAP questionnaires and a retrospective review of the clinical records. Fifty-five pregnancies (carried by 52 women) were included. Five women referred to our centre for the first time while pregnant. Among the remaining 50 pregnancies, documented preconception counseling was noted in 76%, pregnancy planning in 64%. At conception 65.4% of women were on monotherapy, 32.7% on polytherapy, one untreated. Folates were taken during the first trimester in 96.3% of pregnancies, in 43.5% at least since conception. There was one spontaneous and one induced abortion. Obstetric complications occurred in 32.7% of pregnancies. There were 25 cesarean deliveries (47%). There were one twin and one triplet delivery, with a total of 58 offspring. Eleven births were pre-term (19%). Three live-born children (5.7%) carried MCMs, all occurring in unplanned pregnancies with late folate supplementation. According to our findings, preconception counseling of women with epilepsy may be suboptimal even in a tertiary epilepsy centre. Further data are needed to clarify the prevalence of unnecessary cesarean sections in women with epilepsy.