Abstracts

Rationale: While over 25,000 women with epilepsy (WWE) deliver babies each year in the US, careful management by an epilepsy specialist is important to ensure a healthy pregnancy. Serum concentrations of antiepileptic drugs (AEDs) often decrease during pregnancy, increasing risk of seizures and potential fetal injury. Lack of information often causes increased fear and anxiety for WWE, which can lead to poor outcomes. WWE warrant counseling about the effects of epilepsy on pregnancy and best practices to ensure safety. However, effective education requires an experienced provider and consumes a significant amount of time, both of which can be barriers to completion. To optimize care during pregnancy, a task force was convened to develop and implement a Pregnancy in Epilepsy Clinic. Methods: The task force included 3 epileptologists, an epilepsy nurse practitioner, a patient coordinator, and the Neurology Director of Operations. This group met at regular intervals to identify goals, discuss barriers and develop clinic structure. In a survey of baseline performance, obstetricians at our hospital reported difficulty getting a timely epilepsy referral and therefore streamlined scheduling was prioritized. Two clinic sessions were reserved each month for pregnant women with epilepsy. Four distinct office visit templates were created; one visit per trimester and one postpartum visit. Specific teaching points were planned for each visit to provide information at structured intervals, allow appropriate time for effective teaching and avoid overwhelming the patient with information (Table 1). The Obstetrics and Primary Care practices were informed of the clinic and referral process. Results: Since initiation in February 2017, 20 patients have been referred to the pregnancy clinic; 10 were internal referrals from epilepsy center providers and 7 patients were referred from obstetricians. Of the patients referred, 3 were not interested in scheduling an appointment when contacted, 12 patients attended pregnancy clinic appointments, and 5 patients no-showed. The median wait-time from referral to scheduled appointment was 17 days (interquartile range 7-34 days). Our initial analysis revealed the low appointment attendance (29% no-show rate) and differences in referral patterns between obstetricians and epileptologists. The next interventions will be additional appointment reminders to improve attendance and multidisciplinary discussion of high priority indications for referral. We will collect process measures of attendance, delay from referral to appointment, gestational age at first visit, participation in the AED pregnancy registry, documentation of counseling and therapeutic AED levels. We will also follow outcome measures of pregnancy complications and patient satisfaction.  Conclusions: Through the development of this task force, we were able to identify gaps in education and safety for pregnant WWE. We believe a structured, expert clinic with specific content presented at each stage of pregnancy is essential to promoting safer, less stressful pregnancies for WWE. Funding: N/A