More than 100 posters were submitted for consideration ahead of this year’s HPAI Annual Educational Conference, showcasing the huge amount of quality work undertaken across Irish hospital pharmacies this year. Such was the volume of high-quality presentations that some were presented digitally due to physical space constraints.
One of the presenters, Ms Ciara Turner of the Coombe Hospital and Robert Gordon University, Aberdeen, delivered a talk titled ‘A 10-Year Review of Periconceptual Folic Acid Supplementation in Women with Epilepsy Taking Anti-Seizure Medications’. Ms Turner explained that there is strong evidence from two randomised controlled trials to show that periconceptual folic acid supplementation prevents two- thirds of neural tube defects.
“By the time a woman’s pregnancy test is positive, the neural tube is due to close,” said Ms Turner. “Therefore, women should start to take folic acid at least two-to-three months before conception. The WHO recommends specifically that women with epilepsy taking anti- epileptic medication need a high dose of 5mg folic acid.”
In Ireland, the Department of Health issued similar guidelines, which were updated in 2019, said
Ms Turner. “There is strong evidence that anti-epileptic medications
are associated with an increased risk of congenital malformations, including neural tube defects.” She presented data from the Irish and UK register on epilepsy and pregnancy to show that the highest risk is with valproate. “Recommendations on prescribing high-dose 5mg folic acid are supported by Ireland’s National Programme for Epilepsy,” said Ms Turner. “There is also evidence from comprehensive national audits that the prevalence of neural tube defects
has stopped falling in Ireland.” Women taking anti-epilepsy medication and polypharmacy are at increased risk of non-compliance, she noted.
Referring to her study, Ms Turner told the conference: “Based on the results, we make the following recommendations for clinical practice: These key findings need to be communicated to women taking anti-epileptic medications who could become pregnant, intentionally of not, and to the pharmacists and doctors responsible for their prescriptions. The findings should also be communicated to advocacy groups and public health policy-makers.
“Women taking anti-epilepsy medications should have a pre- pregnancy medication review
with a neurologist to review their medication and prescribe folic acid 5mg. Women taking anti-epilepsy medications should ideally attend a multidisciplinary antenatal clinic, supported by a clinical pharmacist, particularly if their dose needs to be adjusted.”
