Women With Epilepsy Often Remain Unaware of Medication’s Pregnancy Risks

LOS ANGELES — Many women of reproductive age who were taking antiseizure medication didn’t fully understand its implications for pregnancy or have care that aligned with their reproductive goals, researchers found.

Of 107 women ages 18-49, 67.3% answered at least one question incorrectly about the teratogenicity of their antiseizure medication or contraceptive drug-drug interactions.

Only 36% were taking folic acid if they were pregnant or planning to become pregnant, or used a highly effective contraceptive if they were not, Tori Valachovic, BS, of the University of Rochester School of Medicine & Dentistry in New York, reported at the American Epilepsy Society meeting.

“It really just brought to the forefront the need for continued education of providers so that they can give accurate information to their patients and follow through with the [American Academy of Neurology] guidelines to have annual conversations around family planning with patients that have childbearing capacity and are taking antiseizure medications,” Valachovic told MedPage Today.

The findings were consistent with prior studies describing lack of knowledge about the risk for birth defects associated with a number of antiseizure medications, in part due to their effect on reducing folate levels, as well as the risk for making hormonal birth control less effective.

“I’m not at all surprised by these results,” commented Kimford Meador, MD, clinical director of the Stanford Comprehensive Epilepsy Center in California. Still, he called the results “depressing.”

Of the more than 30 antiseizure medications, three are seen as “pretty safe” in pregnancy, and another seven or so are known to have either high or intermediate risk, he said. For the other 20, there simply isn’t information yet.

“There’s a lot we don’t know, but even what we do know is not getting out,” Meador told MedPage Today. “Women have a right to know these risks, and they need to know the risks very early in the treatment … If you didn’t talk about these things, how can you call it adequate informed consent?”

The study involved a REDCap survey of 107 people ages 18-49 who were taking antiseizure medications, with branched logic so that the questions were individualized to the medication the patient said she was taking. The surveys were done online in the office after medical visits.

The majority of participants (69 women) said they were using a barrier, hormonal, or implant form of contraception, which could interfere with their medication or vice versa. Six said they were already pregnant or planning to become pregnant. The rest said they abstained from sex, used other forms of contraception, or did not use any contraception.

Of those who planned to become pregnant, 56.1% answered at least one question incorrectly regarding the birth defect risk of their antiseizure medication.

Of those using a barrier, hormonal, or implant contraceptive, 36.2% answered at least one question wrong regarding whether their antiseizure medication decreased birth control effectiveness.

Nevertheless, a whopping 72.9% said they did not want more education about their medication’s risks and interactions with contraception. Only 29.2% of participants who answered at least one question incorrectly said that they wanted more education.

One reason for this might have been wording, Valachovic noted, since it might not have been clear that the education would not immediately commence, and women might have anticipated that this would take more time than they had allotted for their office visit.

Limitations included the modest sample size and single health system from which patients were enrolled. In addition, the majority of patients surveyed were not on medications that were highly concerning from a clinical standpoint.

While the survey participants received a post-survey information sheet regardless of their desire for more education, Valachovic noted that leveraging electronic health systems to automatically prompt and provide information regarding reproductive health topics could help disseminate this information in the clinic.