Pregnancy-related Anticipatory Guidance for People with Epilepsy in Pediatric and Adult Neurology
Amy Tao1, Jasmin Rivero-Guerra2, Katherine McFarlane2, Wesley Kerr2, Page Pennell2, Judy Chang2, Traci Kazmerski2, Elizabeth Harrison2, Laura Kirkpatrick2
1UPMC Children's Hospital of Pittsburgh, 2University of Pittsburgh
Objective:
To assess neurology counseling/care for females with epilepsy (FWE) who subsequently became pregnant.
Background:
Guidelines advise that neurologists counsel FWE about antiseizure medication (ASM) teratogenicity and folic acid (FA).
Design/Methods:
We reviewed health records for primigravida FWE prescribed an ASM who delivered between 6/2014-5/2024 one health system. We evaluated documentation of pre-pregnancy ASMs, counseling about teratogenicity and FA, and whether FWE reported taking FA upon pregnancy. We compared outcomes between FWE under pre-pregnancy pediatric versus adult neurology care using chi-squared or Fisher’s Exact tests. We performed logistic regression to identify predictors of outcomes (candidates: pediatric versus adult neurology, race/ethnicity, intellectual disability (ID), teratogenic ASM, ASM polytherapy).
Results:
173 FWE (84% White non-Hispanic, 9% with ID, median age 27) were included. Twenty-one (12%) transitioned from pediatric to adult neurology due to pregnancy (“transitioned group”) and 152 (88%) were established with adult neurology pre-pregnancy (“adult group”).
In bivariate analysis (transitioned versus adult groups), despite no significant difference in teratogenic ASM prescriptions (19% vs 14%, p>0.05), the transitioned group was less likely to receive counseling about teratogenicity (43% vs 66%, p=0.041). Despite no difference in pre-pregnancy counseling about FA (59% vs. 69%, p>0.05), the transitioned group was less likely to report taking FA upon pregnancy (24% vs 63%, p=0.001).
In logistic regression, significant predictors of teratogenic ASM prescription included ASM polytherapy (OR 3.62, 95% CI 1.48-8.89). Significant predictors of pre-pregnancy counseling about teratogenicity included that ID predicted no counseling (OR 0.18, 95% CI 0.05-0.61). Significant predictors of pre-pregnancy counseling about FA included that teratogenic ASM prescription predicted no counseling (OR 0.30, 95% CI 0.12-0.78). Significant predictors of taking FA upon pregnancy included being established pre-pregnancy with adult neurology (OR 5.21, 95% CI 1.78-15.26).
Conclusions:
Our findings highlight shortcomings in pre-pregnancy counseling/care for FWE, especially FWE in pediatric neurology, with ID, or prescribed teratogenic ASMs.
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