1. Group B presentation – Inderpreet Kaur (GPST1)

2. Scenario A 27 year old lady presents to you as a newly registered patient in your practice. She had recently got married. She has a medical history of epilepsy and has been stable on anti-epileptic medication.

3. Introduction Pre-conceptual counselling should not be confused with antenatal care It is the effective advice and guidance which ensures informed choices and the best possible chance of a healthy pregnancy and healthy baby Often GPs This can be achieved by providing: Optimal care of chronic conditions Lifestyle advice Supplement advice Advice to those at increased risk of genetic malformation

4. Primary Care Although not all pregnancies are planned and many women won’t seek medical advice prior to pregnancy, it is a good opportunity for health promotion if a woman or couple does seek advice Can raise the topic opportunistically during: New registration checks Well woman consultations Contraceptive advice and reviews Medication reviews http://www.fpa.org.uk/sites/default/files/planning-a- pregnancy.pdf

5. Epilepsy The most common major malformations associated with AEDs include neural tube defects, orofacial defects, congenital heart abnormalities, and hypospadias. Minor malformations include hypertelorism, epicanthic folds, and digital hypoplasia. Increases 3 fold with anti-epileptics In a minority of women with epilepsy there may be an increase in the frequency of seizures (between 15% and 37%). 1–2% of women with epilepsy will have a tonic-clonic seizure during labour, and a further 1–2% within the following 24 hours.

6. Advice Reassure the woman that, even on anti-epileptic medication, they are likely to have a healthy pregnancy although the risk of complications during pregnancy and labour is higher. Refer all women taking anti-epileptic drugs (AEDs) to a specialist for review of epilepsy treatment before the woman becomes pregnant, to discuss the relative risks and benefits of adjusting their medication. Advise to: Continue using effective contraception until a full assessment by the specialist has taken place. Not to stop taking her medication unless otherwise directed by the specialist. Should be prescribed folic acid 5 mg daily until the twelfth week of pregnancy. Sodium valporate should be stopped

7. Summary Opportunistic counselling Ensure folic acid – higher dose of 5mg until 12 th week Specialist referral Advise to continue contraception until review Ensure patient understands risks of AEDs and pregnancy Advise to continue medication until specialist review