Anticipatory guidance and care in pediatric and adult neurology for people with epilepsy who became pregnant

Abstract

Objective

To assess documentation of pregnancy-related counseling and care for people with epilepsy of childbearing potential (PWECP) in pediatric and adult neurology who became pregnant.

Methods

We reviewed health records for primigravida PWECP prescribed an antiseizure medication (ASM) who delivered between June 2014 and May 2024 within one academic medical center. We used chi-squared tests to compare counseling, ASM prescriptions, and recommendations for supplemental folic acid between individuals in pediatric and adult neurology care before pregnancy. We performed logistic regression for these outcomes of pre-pregnancy counseling associated with type of neurology care, race, ethnicity, intellectual disability (ID), teratogenic profile of ASMs prescribed, and ASM polytherapy.

Results

173 PWECP (84 % White non-Hispanic, 9 % with intellectual disability (ID) were included. Twenty-one (12 %) transferred from pediatric to adult neurology care due to pregnancy (“pediatric group”) and 152 (88 %) were previously established with adult neurology (“adult group”). PWECP in the pediatric group compared to the adult group had lower rates of documentation of clinician discussion of ASM teratogenicity (43 % vs 66 %, p = 0.041) and folic acid use (24 % vs 63 %, p = 0.001) before pregnancy. PWECP established with adult neurology prior to pregnancy were significantly more likely to have been taking folic acid before pregnancy (OR 5.21, 95 % CI 1.78–15.3). Individuals with ID were significantly less likely to have documentation of discussion of ASM teratogenicity (OR 0.18, 95 % CI 0.05–0.62).

Conclusion

Our findings suggest a need for improvement in providing pre-pregnancy guidance and care for PWECP, especially for PWECP in pediatric neurology care and those with ID.