Abstracts

Rationale: Women with epilepsy (WWE) who are of childbearing potential have different information needs compared to men, due to the impact of epilepsy and antiepileptic drugs (AEDs) on contraception, pregnancy and birth outcomes. We sought to investigate the impact of a new multidisciplinary clinic in bridging the knowledge gap of this special population.Methods: A new Pregnancy/Contraception Counseling and Prenatal Epilepsy Clinic (PPEC) was established at the University of Colorado Hospital to address the educational needs of WWE and to provide specialized prenatal epilepsy care. The Department of Neurology worked closely with the Skaggs School of Pharmacy and the Department of Obstetrics and Gynecology to develop this pilot project. To assess baseline knowledge and information gaps, a questionnaire was developed based on the 2014 American Academy of Neurology (AAN) and American Epilepsy Society (AES) Quality Measure on the Counseling for Women of Childbearing Potential with Epilepsy. All patients referred to PPEC who had a diagnosis of epilepsy and were not cognitively impaired were given the questionnaire on their first visit. This was followed by an in-depth discussion with an epileptologist on issues related to pregnancy, medication risks and contraception. They were reassessed using the same questionnaire after the counseling.Results: A total of 30 patients who met the criteria were assessed at the PPEC between July 2014 and June 2015: 19 were pregnant and 6 were not pregnant at the first clinic visit. The median age of the group was 27 years (range 18 – 37 years). The median score for the questionnaire was 33% (range 0-67%) before counseling versus 88% (range 50-100%) after counseling. Prior to counseling, almost half of the women were aware of the interactions between some AEDs and contraceptives, and that pregnancy may change the disposition of AEDs. About 40% were aware that taking folic acid before pregnancy lowers the risk of having babies with major congenital malformation. However, only 6% of women knew that seizure freedom for at least nine months prior to pregnancy would reduce the risk of seizures during pregnancy. Similarly, only 6% knew that some AEDs may have negative impact on the neurodevelopmental of children if exposed in-utero. The baseline knowledge of the impact of epilepsy on pregnancy and birth outcome was low. Majority also hold the misconception that WWE were more likely to have problems during their pregnancies. For those questions that were answered correctly in less than 20% of patients at baseline, counseling improved the percentage by a median change of 53% (range 42-69%).Conclusions: The issues related to contraception and pregnancy in WWE of childbearing potential are complex and require dedicated time and expertise for optimal education. Our current data demonstrate significant knowledge gap in this area which can be improved through a multidisciplinary clinic.