Background and methodology It is our experience that women who are already pregnant are commonly referred to our service for advice about the safety of anti-epileptic drug regimens. We know of no study that explores why epilepsy-specific preconception advice may be suboptimal. Women who had been referred to the epilepsy service before or during their most recent pregnancy were invited for interview. A thematic analysis of the interviews was used to compare the factors in women who planned their pregnancies with those who did not.

Results Over half the women had an unplanned pregnancy and most considered they had received inadequate advice from primary care. Women with planned pregnancies sought out information, perceived the teratogenesis risks as more threatening, and were proactive in seeking a safe pregnancy. Women with unplanned pregnancies seemed less threatened by the risks of teratogenesis, experienced more social disadvantage, were more likely to have misunderstandings about epilepsy and pregnancy, and were vulnerable to deficiencies in primary care epilepsy management.

Discussion and conclusions The success of counselling was determined by a combination of access to care, and the attitudes and social context of women. Identifying those women at risk of unplanned pregnancy and tailoring counselling and treatment to their needs may reduce adverse pregnancy outcomes.