Abstracts

Rationale: The physiological, pharmacological, and psychological changes associated with pregnancy in adolescents and young adults (AYA) with epilepsy has not been studied. Guidelines were published in 2009 by the American Academy of Neurology and American Epilepsy Society regarding management of women with epilepsy (WWE), including one section focused on pregnancy, however AYA were not discussed as a separate population within these guidelines. Three to five births per 1,000 will be to WWE of childbearing age. Rates for AYA in the general population range from 15.4 births per 1,000 ages 15-17 years to 54.1/1,000 in ages 18-19 years. AYA and WWE may have a moderately increased risk of delivery via cesarean section (CS) at a higher rate than the general population, but the medical necessity underlying the decision has not been well-documented. Across pediatric conditions, adolescents are at higher risk for treatment nonadherence, and thus for poorer disease control, which may be a risk factor for poor pregnancy outcomes and CS delivery. Recognizing the challenges associated with pregnancy in adolescents with epilepsy, a transdisciplinary AYA epilepsy and pregnancy clinic was implemented at our institution as a strategy to reduce seizure burden and improve outcomes of the mother and child. Methods: Participants were 7 pregnant AYA (median age 17; range 15-23 years) with confirmed or provoked epilepsy receiving epilepsy management in a specialized clinic. Seizure frequency, antiepileptic medication, serum concentrations, medication changes, pregnancy outcome and pre-pregnancy counseling were obtained through a retrospective medical chart review. Results: Six patients had documented pre-pregnancy counseling based on WWE guidelines and 4 were taking folic acid at time of referral to clinic. Only 3 patients were adherent to prescriber-recommended dose changes and antiepileptic drug (AED) level measurement, and 4 patients required ≥ 1 AED dose increases based on subtherapeutic levels or breakthrough seizures. Five patients experienced ≥ 50% reduction in seizure frequency during pregnancy compared to 9 months immediately prior to pregnancy, with 2 patients remaining seizure free during both time periods. Pregnancy-related outcomes are presented in Table 1. Conclusions: Overall seizure frequency in our population decreased during pregnancy and delivery. AED drug monitoring during gestation demonstrated dynamic pharmacokinetic changes in pregnant AYA and support close monitoring to maintain levels within a therapeutic range. Recurrent seizures were associated with subtherapeutic serum levels, attributable to either pharmacokinetic changes or non-adherence to AED therapy. Increased rates of CS and spontaneous abortion were observed for our patients compared to those reported for WWE. All but one of our AYA received pre-pregnancy counseling per the WWE Guidelines. Supportive counseling in combination with close monitoring of drug levels and adherence in pregnant adolescents and young adults with epilepsy is needed to optimize maternal and infant health.