Preconceptual care for women with spina bifida

Background

When women with spina bifida reach reproductive age they may have concerns about the potential complications they may face during pregnancy. Over the last year six women with spina bifida have been seen in our preconceptual clinic.

Study design

Retrospective case series n = 6.

Setting

St Mary's Hospital, Manchester. A tertiary referral centre.

Aim

To describe recurrent themes covered during pre-conceptual counselling of women with spina bifida.

Results

Common themes emerged during the six consultations. These related to the need for preconceptual folic acid supplementation (6/6), discussion of recurrence risks (6/6), screening for neural tube defects (6/6), management of urinary symptoms and urinary infection (5/6), potential problems with backpain, mobility and the ability to continue to work during pregnancy (6/6), analgesia in labour (6/6), anaesthesia (3/6), mode of delivery (6/6). Management options for the above were discussed. All women reported that they had found the consultation to contain useful information and that the actual risks were not as high as they perceived. They were also reassured by the suggested management plans. Two of the women have become pregnant.

Conclusion

For women with spina bifida a preconceptual consultation provides an opportunity to reinforce advice regarding folic acid. The provision of information, acknowledgement of potential problems and the discussion of management options in a preconceptual clinic appears to reduce anxieties about pregnancy.