Women in England should receive a check-up with their GP 6-8weeks after giving birth. This ‘six-week check’ should focus on the mother’s mental health and general wellbeing, their return to physical health, family planning and contraception, and any conditions that existed before or arose during pregnancy that may need further care. Recent research has found that more than a third of women are not getting a six-week check. However, we do not know if women who have other health problems are more or less likely to get their six-week check, or if this check improves women's health longer term.
Epilepsy is a brain disorder that causes frequent seizures. Seizures are sudden bursts of electrical activity in the brain that can cause temporary changes in behaviour, movements, feelings and levels of consciousness. This study explores whether women with epilepsy are more or less likely than a group of women without epilepsy from the general population who have recently given birth to receive their six-week check. We will find out if any differences in the likelihood of receiving a six-week check between these women can be explained by differences in their characteristics such as their age, ethnicity, and where they live. We will then examine whether receiving a six-week check affects the chance of women with and without epilepsy using contraception or having health problems detected or treated in the first year after giving birth. This will help us understand whether receiving a six-week check plays a role in improving maternal outcomes.
While a maternal postpartum six-week check (SWC) with a GP has long been recommended, it only became an essential service in 2020. However, there is limited evidence for the effectiveness of the SWC in improving women’s longer-term health and wellbeing. This study aims to describe the provision of the maternal postpartum SWC in a specific high-risk group, women with epilepsy, in comparison to women without epilepsy, and whether receiving a check is associated with improved maternal outcomes in the first year postpartum.
The CPRD-Aurum pregnancy register and Hospital Episode Statistics will be used to create a cohort of pregnancies ending in a live birth or stillbirth between 1998-2022 to women with epilepsy along with a random population sample of pregnancies to women without epilepsy. Descriptive analyses will assess the prevalence of the SWC among the women with and without epilepsy. Modified Poisson regression will be used to investigate if any inequity in the provision of the SWC between these women can be explained by differences in their characteristics. Appropriate regression approaches (e.g.logistic regression for rare binary outcomes or survival analysis approach to allow for follow-up time and take account of censoring) will then be used to examine if the women with epilepsy are more or less likely than the women without epilepsy to be prescribed contraception or have adverse outcomes detected/treated in the postpartum period, and to examine if this is influenced by receiving a SWC. Regression approaches will also be used to examine whether receiving a SWC influences the subsequent likelihood of having contraception prescribed or adverse outcomes detected/treated in the postpartum period among women with and without epilepsy.
This will provide evidence that will support improvements in patient care in the postpartum period, particularly for women with epilepsy who disproportionately experience poorer outcomes.
Receipt of postpartum care:
Maternal six-week postpartum check (SWC);
Other postnatal care with GP, e.g. contraception advice, BP check, physical examination;
Impact on postpartum outcomes (not epilepsy specific)
Prescribed contraception: prescriptions for female prophylactic contraception (long-term e.g. implant and intrauterine device or contraceptive pill) and emergency contraception (levonorgestrel or ulipristal acetate);
Subsequent conception <12 months after giving birth;
Urinary and/or faecal incontinence;
Postpartum depression and/or anxiety
Dyspareunia, painful intercourse, perineal/pelvic pain
Impact on postpartum outcomes (epilepsy specific)
Unplanned hospital admission for epilepsy;
A&E visit for epilepsy;
Mortality
No recording of pregnancy prevention plan in GP records for women prescribed sodium valproate
Claire Carson - Chief Investigator - University of Oxford
Kate Fitzpatrick - Corresponding Applicant - Nuffield Department of Population Health
Aden Kwok - Collaborator - University of Oxford
Chris Gale - Collaborator - Imperial College London
Dimitrios Siassakos - Collaborator - University College London ( UCL )
Fiona Alderdice - Collaborator - University of Oxford
Julia Sanders - Collaborator - Cardiff University
Maria Quigley - Collaborator - University of Oxford
Sara Kenyon - Collaborator - University of Birmingham
Yangmei Li - Collaborator - University of Oxford
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;CPRD Aurum Pregnancy Register