Exploring the perception of women with epilepsy about pregnancy concerns
A qualitative study
Keywords:
Epilepsy, Pregnancy outcomes, Reproductive health, Need assessmentAbstract
Background and aim: Epilepsy is a common neurological disorder in pregnancy, which is associated with increased maternal and fetal adverse outcomes. This study aimed to explore the reproductive healthcare needs of women with epilepsy before, during and after childbirth. Methods: This was a qualitative study using a content analysis method. The study population was marital women with epilepsy in reproductive age (15-45 years) referred to Imam Hossein Hospital, Tehran, Iran. Participants were 16 women chosen using purposive sampling with the consideration of maximum variation in sampling. Semi-structured interviews were held with the participants until data saturation was reached. The data were analyzed using the content analysis method. The MAXQDA software, version 2010, was used for the management of data. Results: The data analysis led to the development of two categories. The first one is named ‘resilience against threats to safe pregnancy’ and has the following subcategories: (1) real physical complications and perceived (mental) conditions due to unwanted pregnancies, (2) the predisposing factors of anxiety related to safe pregnancy, (3) perceived consequences of pregnancy’, and (4) the approach to encounter perceived consequences of pregnancy. The second category is called ‘adverse experiences under inefficient supportive systems’ and has the following subcategories: (1) the insufficiency of reproductive healthcare services for women with epilepsy, (2) doubt about the advantages and disadvantages of breastfeeding, (3) stigma as a block to the treatment of the postpartum depression, and (4) playing the motherhood role under the shadow of self-esteem to lack of self-esteem. Conclusion: In the prenatal, natal and postnatal duration, because of supportive system disruption and not receiving proper consultation, participants were often worried about not being able to get favorable conditions for safe pregnancy and controlling process of their pregnancy. Therefore, they often experienced unwanted pregnancy. They were also concerned about the adverse fetal outcomes. In postpartum period, they often experienced postpartum depression and were very doubtful about breastfeeding.References
Longo DL, Harrison TR, Longo Dan L, Fauci A , Kasper DL , Hauser S L, et al. Harrison's principles of
internal medicine. 18 ed ed. New York: McGraw-Hill Medical; 2012.
Viinikainen K, Heinonen S, Eriksson K, Kälviäinen R. Community‐based, Prospective, Controlled Study
of Obstetric and Neonatal Outcome of 179 Pregnancies in Women with Epilepsy. Epilepsia. 2006; 47(1):
-92. doi: 10.1111/j.1528-1167.2006.00386.x. PMID: 16417548.
Fairgrieve SD, Jackson M, Jonas P, Walshaw D, White K, Montgomery TL, et al. Population based,
prospective study of the care of women with epilepsy in pregnancy. BMJ. 2000; 321(7262): 674-5. doi:
1136/bmj.321.7262.674.
Cunningham G, Leveno KJ, Bloom SL, Spong CY, Dashe JS. Williams Obstetrics. 24th edition; 2014.
Kochen S, Salera C, Seni J. Pregnant women with epilepsy in a developing country. Open Neurol J. 2011;
: 63-7. doi: 10.2174/1874205X01105010063. PMID: 22046203 PMCID: PMC3204418.
Thompson D, Thomas H, Solomon J, Nashef L, Kendall S. Chronic illness, reproductive health and moral
work: women's experiences of epilepsy. Chronic Illn. 2008; 4(1): 54-64. doi: 10.1177/1742395307086696.
PMID: 18322030.
Davis AR, Pack AM, Kritzer J, Yoon A, Camus A. Reproductive history, sexual behavior and use of
contraception in women with epilepsy. Contraception. 2008; 77(6): 405-9. doi:
1016/j.contraception.2008.02.002. PMID: 18477488.
Dennis AJ. Identifying and responding to the reproductive decision-making needs of women with epilepsy.
Boston University; 2012.
Weckesser A, Denny E. Women living with epilepsy, experiences of pregnancy and reproductive health: A
review of the literature. Seizure. 2013; 22(2): 91-8. doi: 10.1016/j.seizure.2012.11.001. PMID: 23182977.
Helbig KL, Bernhardt BA, Conway LJ, Valverde KD, Helbig I, Sperling MR. Genetic risk perception and
reproductive decision making among people with epilepsy. Epilepsia. 2010; 51(9): 1874-7. doi:
1111/j.1528-1167.2009.02507.x. PMID: 20163441.
Gaffield ME, Culwell KR, Lee CR. The use of hormonal contraception among women taking
anticonvulsant therapy. Contraception. 2011; 83(1): 16-29. doi: 10.1016/j.contraception.2010.06.013.
PMID: 21134499.
Veiby G, Daltveit AK, Schjølberg S, Stoltenberg C, Øyen AS, Vollset SE, et al. Exposure to antiepileptic
drugs in utero and child development: A prospective population‐based study. Epilepsia. 2013; 54(8):
-72. doi: 10.1111/epi.12226. PMID: 23865818, PMCID: PMC3766256.
Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and
measures to achieve trustworthiness. Nurse educa today. 2004; 24(2): 105-12. doi:
1016/j.nedt.2003.10.001. PMID: 14769454.
Turner K, Piazzini A, Franza A, Canger R, Canevini MP, Marconi AM. Do Women with Epilepsy Have
More Fear of Childbirth During Pregnancy Compared with Women without Epilepsy? A Case‐Control
Study. Birth. 2008; 35(2): 147-52. doi: 10.1111/j.1523-536X.2008.00228.x. PMID: 18507586.
Winterbottom JB. Women with epilepsy preparing for pregnancy: a qualitative analysis. University of
Liverpool. 2012. Available from: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.603556.
Remennick L. Childless in the land of imperative motherhood: Stigma and coping among infertile Israeli
women. Sex roles. 2000; 43(11-12): 821-41. doi: 10.1023/A:1011084821700.
Dyer SJ, Abrahams N, Hoffman M, van der Spuy ZM. Men leave me as I cannot have children': women's
experiences with involuntary childlessness. Hum Reprod. 2002; 17(6): 1663-8. doi:
1093/humrep/17.6.1663. PMID: 12042295.
Widnes SF, Schjøtt J, Granas AG. Risk perception and medicines information needs in pregnant women
with epilepsy–A qualitative study. Seizure. 2012; 21(8): 597-602. doi: 10.1016/j.seizure.2012.06.007.
PMID: 22762859.
Lee SM, Nam HW, Kim EN, Shin DW, Moon HJ, Jeong JY, et al. Pregnancy-related knowledge, risk
perception, and reproductive decision making of women with epilepsy in Korea. Seizure. 2013; 22(10):
-9. doi: 10.1016/j.seizure.2013.07.002. PMID: 23890718.
Walsh-Gallagher D, Sinclair M, Mc Conkey R. The ambiguity of disabled women's experiences of
pregnancy, childbirth and motherhood: a phenomenological understanding. Midwifery. 2012; 28(2): 156- 62. doi: 10.1016/j.midw.2011.01.003. PMID: 21570753.
Carolan MC. Towards understanding the concept of risk for pregnant women: some nursing and midwifery
implications. J Clin Nurs. 2009; 18(5): 652-8. doi: 10.1111/j.1365-2702.2008.02480.x. PMID: 18705630.
Oakley A. Social consequences of obstetric technology: the importance of measuring “soft” outcomes.
Birth. 1983; 10(2): 99-108. doi: 10.1111/j.1523-536X.1983.tb01408.x.
Welch L, Miller L. Emotional and Educational Components of Pregnancy. Glob libr women's med. 2008.
Qiang JK, Nyhof-Young J, D'Souza R, Bui E. Support systems of women with epilepsy in pregnancy: A
retrospective needs assessment. Seizure. 2016; 36: 1-3. doi: 10.1016/j.seizure.2015.12.017.
Galanti M, Newport DJ, Pennell PB, Titchner D, Newman M, Knight BT, et al. Postpartum depression in
women with epilepsy: influence of antiepileptic drugs in a prospective study. Epilepsy & Behavior. 2009;
(3): 426-30.doi: 10.1016/j.yebeh.2009.07.009.
Bjørk MH, Veiby G, Reiter SC, Berle JØ, Daltveit AK, Spigset O, et al. Depression and anxiety in women
with epilepsy during pregnancy and after delivery: A prospective population‐based cohort study on
frequency, risk factors, medication, and prognosis. Epilepsia. 2015; 56(1): 28-39. doi: 10.1111/epi.12884.
PMID: 25524160.
Robertson E, Lyons A. Living with puerperal psychosis: A qualitative analysis. Psychology and
Psychotherapy. 2003; 76(4): 411-31. doi: 10.1348/147608303770584755.
Edwards E, Timmons S. A qualitative study of stigma among women suffering postnatal illness. Journal of
Mental Health. 2009. doi: 10.1080/09638230500271097.
Bjørk MH, Veiby G, Engelsen BA, Gilhus NE. Depression and anxiety during pregnancy and the
postpartum period in women with epilepsy: A review of frequency, risks and recommendations for
treatment. Seizure. 2015; 28: 39-45. doi: 10.1016/j.seizure.2015.02.016. PMID: 25777784.
Pashley S, O'Donoghue MF. The safety of anti-epileptic drug regimens: a qualitative study of factors
determining the success of counselling women before conception. J Fam Plann Reprod Health Care. 2009;
(3): 153-6. doi: 10.1783/147118909788708002. PMID: 19622204.
Thomas SV. Managing epilepsy in pregnancy. Neurol India. 2011; 59(1): 59-65. doi: 10.4103/0028- 3886.76860. PMID: 21339661.
Meador K, Pennell P, Harden C, Gordon J, Tomson T, Kaplan P, et al. Pregnancy registries in epilepsy a
consensus statement on health outcomes. Neurology. 2008; 71(14): 1109-17. doi:
1212/01.wnl.0000316199.92256.af. PMID: 18703463.
Abe K, Hamada H, Takahiro Yamada T, Obata-Yasuoka M, Minakami H, Yoshikawa H. Impact of
planning of pregnancy in women with epilepsy on seizure control during pregnancy and on maternal and
neonatal outcomes. Seizure. 2014; 23(2): 112-6. doi: 10.1016/j.seizure.2013.10.003. PMID: 24183922.
McAuley JW, Patankar C, Lang C, Prasad M. Evaluating the concerns of pregnant women with epilepsy: a
focus group approach. Epilepsy Behav. 2012; 24(2): 246-8. doi: 10.1016/j.yebeh.2012.03.014. PMID:
Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, et al. Breastfeeding in
children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA pediatrics. 2014;
(8): 729-36. doi: 10.1001/jamapediatrics.2014.118. PMID: 24934501 PMCID: PMC4122685.
Harden CL. Beneficial or neutral effect of breastfeeding on cognitive outcomes in children of mothers with
epilepsy? JAMA pediatrics. 2014; 168(8): 699-700. doi: 10.1001/jamapediatrics.2014.420. PMID:
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