Assessment of the adequacy of counselling regarding reproductive-related issues in women of childbearing age on anti-epileptic drugs.

BACKGROUND: The use of anti-epileptic drugs (AEDs) in women of childbearing age (WCBA) necessitates careful counselling regarding reproductive-related issues. AIMS: 1) To compare documentation of appropriate counselling regarding reproductive-related issues in WCBA prescribed AEDs for non-epilepsy versus epilepsy indications, and 2) to examine whether the frequency of counselling improved after introduction of 'standardised 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 standardised typed passages regarding potential teratogenicity +/- interactions with hormonal contraception at a university teaching hospital. Chi-squared or Fisher exact tests were 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% versus 49%, P = 0.002), but was no longer significantly different in study period B (86% versus 79%, P = 0.64). Documentation of counselling regarding potential interaction of enzyme-inducing AEDs with hormonal contraception did not significantly change between study periods. CONCLUSIONS: Significant improvements in documentation regarding potential teratogenicity of AEDs prescribed for non-epilepsy indications can be achieved by introducing standardised, typed passages copied to patients. Such a practice change is practical and widely-applicable to neurological and non-neurological practice worldwide.