Our experience that women who are already pregnant are referred to our service for advice about antiepileptic drug regimens’ safety. We know of no study that explores why epilepsy-specific preconception advice may be suboptimal. Women who had been referred to the epilepsy service before or during their most recent pregnancy were invited for an interview. A thematic analysis of the talks to compare women who planned their pregnancies with those who did not.

Over half the women had an unplanned pregnancy, and most considered, they had received bad advice from primary care. Women with planned pregnancies sought out information, perceived the teratogenesis risks as more threatening, and were proactive in seeking a safe pregnancy. Women with unplanned pregnancies seemed less threatened by the dangers of teratogenesis, experienced more social disadvantage, were more likely to misunderstand epilepsy and pregnancy and were vulnerable to primary care epilepsy management deficiencies.

The study concluded that counseling success was determined by a combination of access to care and women’s attitudes and social context. Identifying those at risk of unplanned pregnancy and tailoring counseling and treatment to their needs may reduce adverse pregnancy outcomes.

Reference: https://srh.bmj.com/content/35/3/153