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Abstract Details

Pregnancy-related Anticipatory Guidance for People with Epilepsy in Pediatric and Adult Neurology
Epilepsy/Clinical Neurophysiology (EEG)
P1 - Poster Session 1 (11:45 AM-12:45 PM)
9-015
To assess neurology counseling/care for females with epilepsy (FWE) who subsequently became pregnant.  
Guidelines advise that neurologists counsel FWE about antiseizure medication (ASM) teratogenicity and folic acid (FA).
We reviewed health records for primigravida FWE prescribed an ASM who delivered between 6/2014-5/2024 in 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).

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).
Our findings highlight shortcomings in pre-pregnancy counseling/care for FWE, especially FWE in pediatric neurology, with ID, or prescribed teratogenic ASMs.
Authors/Disclosures
Amy K. Tao
PRESENTER 		Ms. Tao has nothing to disclose.
Jasmin Rivero-Guerra, Student-Worker Ms. Rivero-Guerra has nothing to disclose.
Katherine McFarlane, MS (University of Pittsburgh) Ms. McFarlane has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. Ms. McFarlane has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neuropace.
Wesley Kerr, MD, PhD (University of Pittsburgh) Dr. Kerr has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for SK Lifesciences. Dr. Kerr has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven Pharmaceuticals. Dr. Kerr has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Kerr has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neurelis. Dr. Kerr has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for QurAlis. Dr. Kerr has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven Pharmaceuticals. Dr. Kerr has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Epilepsia. The institution of Dr. Kerr has received research support from NINDS. The institution of Dr. Kerr has received research support from American Epilepsy Society. The institution of Dr. Kerr has received research support from 好色先生. The institution of Dr. Kerr has received research support from SK Life Science. The institution of Dr. Kerr has received research support from Biohaven Pharmaceuticals. Dr. Kerr has received publishing royalties from a publication relating to health care.
Page B. Pennell, MD, FAAN (University of Pittsburgh School of Medicine) The institution of Dr. Pennell has received research support from NIH.
Judy Chang, MD The institution of Dr. Chang has received research support from NIH. The institution of Dr. Chang has received research support from NIH. The institution of Dr. Chang has received research support from NIH.
Traci Kazmerski The institution of Traci Kazmerski has received research support from Cystic Fibrosis Foundation. The institution of Traci Kazmerski has received research support from NIH.
Elizabeth Harrison, MD (UPMC Children's Hospital of Pittsburgh) Dr. Harrison has nothing to disclose.
Laura A. Kirkpatrick, MD (UPMC Children's Hospital of Pittsburgh) The institution of Dr. Kirkpatrick has received research support from American Epilepsy Society. The institution of Dr. Kirkpatrick has received research support from Child Neurologist Career Development Program. The institution of Dr. Kirkpatrick has received research support from Child Neurology Foundation. The institution of Dr. Kirkpatrick has received research support from Rosenau Family Research Foundation. The institution of Dr. Kirkpatrick has received research support from Society of Family Planning. The institution of Dr. Kirkpatrick has received research support from Pediatric Epilepsy Research Consortium. Dr. Kirkpatrick has received personal compensation in the range of $500-$4,999 for serving as a Meeting Attendee with One8 Foundation. Dr. Kirkpatrick has received personal compensation in the range of $500-$4,999 for serving as a Meeting Attendee with Brigham and Women's Hospital. Dr. Kirkpatrick has received personal compensation in the range of $0-$499 for serving as a Meeting Attendee with Pediatric Epilepsy Research Consortium. Dr. Kirkpatrick has received personal compensation in the range of $0-$499 for serving as a Grant reviewer with Society of Family Planning. Dr. Kirkpatrick has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Norton Children's Hospital. Dr. Kirkpatrick has a non-compensated relationship as a Board of Directors member with My Epilepsy Story that is relevant to AAN interests or activities.