To assess Neurology trainees’ knowledge, practices, and comfort in management of neurological disease in women of child-bearing age, and during pregnancy and breastfeeding.

Knowledge gaps among neurologists caring for women with epilepsy have previously been identified. Perception and comfort level of trainees in safely caring for women of child-bearing age with neurologic diseases remains to be assessed.

A thirty-question survey was administered in this cross-sectional study, using Google forms.  Questions were designed based on guidelines from the ºÃÉ«ÏÈÉú – which explored trainees’ knowledge of safe drugs to be used during pregnancy and breastfeeding in women with epilepsy, multiple sclerosis (MS) and headache, interactions with contraceptives and endocrine side effects. Current practices and trainees’ level of comfort in addressing the above were explored.

Twelve residents responded (neurology training post-graduate year I [n=6/12], II [n=3/12] and III [n=3/12]). 75% of trainees indicated they frequently encountered women of child-bearing age; 91% felt a curriculum pertaining to neurological diseases in women would be relevant and helpful. Majority expressed lack of confidence addressing pertinent reproductive health issues in women with epilepsy [74%], multiple sclerosis [83%], and headaches [58%]. Only 30% routinely asked women on anti-epileptic therapy about reproductive disorders and disruptions in menstrual cycle and 42% routinely counseled on folate supplementation. With regards to migraine prevention, 66% of respondents were able to identify safe pharmacologic agents during lactation. A majority (91%) correctly picked safest disease modifying therapy (DMT) for MS during pregnancy, however, only 25% identified risk of rebound activation after discontinuation of certain DMTs.  All respondents identified that structured resources such as flash-cards would prove useful with their care for women with neurological diseases.

This survey identifies the need for implementing early structured education in neurology training curriculum to support residents in safely caring for women with neurologic disease.