Pregnancy and Breastfeeding: A Survey of People with Epilepsy about their Experiences and Attitudes
Laura Kirkpatrick1, Elizabeth Gerard2, Paula Voinescu3, Alison Pack4, Denise Li5, Erica Kemp6, Page Pennell6
1UPMC Children's Hospital of Pittsburgh, 2Northwestern University, 3Brigham and Women'S Hospital, 4Neurological Institute, Columbia University, 5University of Pittsburgh, 6University of Pittsburgh School of Medicine
Objective:
To understand the experiences and attitudes of persons with epilepsy of gestational capacity (PWEGC) regarding pregnancy and breastfeeding. 
Background:
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Design/Methods:
A market research firm recruited PWEGC ages 18-45 years old currently taking an antiseizure medication (ASM) from a nationally representative panel to complete a survey. Respondent groups were compared by chi-square analysis.
Results:

Of 199 respondents, 62 recently had a child, 30 were pregnant, 91 were considering pregnancy, and 16 decided not to have a child.

Over two-thirds of respondents believe that pregnancy is at least somewhat safe for PWEGC. A higher proportion of respondents who recently had a child or are pregnant/considering pregnancy believe that pregnancy planning is important compared to those who decided not to have a child (p<0.05).  

The most prevalent concerns cited by participants who were currently pregnant/considering pregnancy were prenatal exposure to ASMs (50%) and pregnancy impacting seizure control (50%). The most prevalent concern of participants who recently had a child was heritability of epilepsy (58%).

Seventy-five percent of participants who recently had a child, or who are pregnant/considering pregnancy, report that reassurance from their physician is the leading factor in deciding to have a child. Forty-eight percent of these respondents were prescribed a different ASM once considering pregnancy, with adjustments <3 months for most. Among participants who chose to breastfeed, 53% were told by physicians that breastfeeding is safe while taking ASMs. Among participants who chose not to breastfeed, 61% had concerns about transmission of ASMs to the baby and 21% reported that they were told by physicians not to breastfeed because of their ASMs. 

Conclusions:
Findings illuminate concerns of PWEGC regarding reproductive health and highlight the provider’s important role in shared decision-making. Results may inform best practices for providers counseling and educational initiatives for patients and providers.
10.1212/WNL.0000000000201843