A Retrospective Analysis of Reproductive Health Medications and Procedures Among Adolescent and Young Adult People with Epilepsy of Childbearing Potential
Abstract number :
1.239
Submission category :
4. Clinical Epilepsy / 4E. Women's Issues
Year :
2023
Submission ID :
73
Source :
www.aesnet.org
Presentation date :
12/2/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Elizabeth Harrison, MD, MS – UPMC Children's Hospital of Pittsburgh
Laura Kirkpatrick, MD – UPMC Children's Hospital of Pittsburgh; Harry Hochheiser, PhD – Biomedical Informatics – University of Pittsburgh School of Medicine; Yoshimi Sogawa, MD – UPMC Children's Hospital of Pittsburgh; Traci Kazmerski, MD, MS – UPMC Children's Hospital of Pittsburgh
Rationale: Adolescent and young adult people with epilepsy of childbearing potential (PWECP) are uniquely vulnerable to a variety of adverse health outcomes, specifically those related to teratogenic anti-seizure medications (ASMs) and drug-drug interactions between ASMs and contraceptives that can lead to poor seizure control and/or contraceptive failure. To better understand reproductive healthcare provision for PWECP, we conducted a retrospective analysis of relevant reproductive health outcomes.
Methods: We retrospectively analyzed procedural and medication data for PWECP ages 13-21 years (n=1456) between 2011 and 2021 at a single academic medical center to investigate rates of the following outcomes: (1) prescription of folic acid, (2) prescription of an enzyme-inducing ASM within one year of hormonal contraception initiation, (3) prescription of lamotrigine within one year of a contraceptive that could affect lamotrigine levels, and (4) documentation of any contraceptive medication or device insertion within one year of teratogenic ASM initiation. We performed statistical analyses in a Jupyter Notebook using the Python module statsmodels with sample proportion z-tests.
Results: Among 1456 PWECP, less than half (41%, n=598) were prescribed folic acid during the study period (95% CI 38.5-43.6%, p< 0.001). Of PWECP prescribed an enzyme-inducing ASM (carbamazepine, felbamate, oxcarbazepine, phenytoin, phenobarbital, primidone, or rufinamide), 11% (56/503) were prescribed a hormonal contraceptive that could have had lowered effectiveness from the ASM (oral contraceptive pills, the vaginal ring, the contraceptive patch, or the progesterone implant) within one year of the ASM prescription (95% CI 8.4-13.9%, p< 0.001). Of those prescribed lamotrigine, 13% (64/485) had documentation of an estrogen-containing medication that could affect lamotrigine levels (hormone replacement therapy, combined oral contraceptive pills, the vaginal ring, or the contraceptive patch) within one year of that prescription (95% CI 10.2-16.2%, p< 0.001). Of those prescribed a teratogenic ASM (valproic acid, phenobarbital, phenytoin, carbamazepine, topiramate, or primidone), less than one-quarter (21%, 143/692) had documentation of contraception (oral contraceptive pills, the vaginal ring, the contraceptive patch, medroxyprogesterone acetate injections, the progesterone implant, or an intrauterine device) within one year of that ASM prescription (95% CI 17.6-23.7%, p< 0.001).
Clinical Epilepsy