To evaluate whether female patients attending a tertiary hospital epilepsy service are counselled on folic acid supplementation and contraceptive measures, according to national clinical guidelines.

Women with epilepsy (WWE) require a more monitored and guided treatment approach compared to the rest of the epilepsy population. This is due to the known teratogenic side effects of many AEDs, making contraception and preconception care crucial for these patients. National clinical guidelines for this group advise high dose folic acid supplementation - of particular importance, as certain AEDs may disrupt folate metabolism. Counselling regarding contraception and AED risk is also advised, as contraceptive efficacy may be altered by certain AEDs, and all patients should be informed of potential AED-associated teratogenicity.

This audit was performed by reviewing epilepsy outpatient clinic notes on the electronic patient record (EPR)  between 30/03/2022 to 27/07/2022. It was verified if WWE of childbearing age were prescribed folic acid, counselled on contraceptive use and on AED risks, as recommended by national guidelines.

Despite two major Irish guidelines recommending folic acid supplementation, only 58.7% of patients were taking this regularly. Regarding WWE with Intellectual Disability (ID), only 34.3% of these patients were taking folic acid, compared to 69.7% of the remaining WWE without ID. 66% of patients were not using reliable contraception, despite 74.3% having been counselled about AED risks and thus need for contraception. There lacked discussion about AED-associated teratogenicity for 26.7% of patients.

This audit demonstrates a divide between national guidelines and clinical practice regarding the reproductive health of WWE. A large group not taking folic acid nor on contraception are those with ID, thus leading to the question of reproductive health and safety for this cohort.

It highlights the need for further education of specialist teams regarding these guidelines, to improve patient care and reproductive safety for WWE.