Is Folic Acid for Reduction of Anticonvulsants' Teratogenic Risk Part of the Standard Neuro-Psychiatric Clinical Practice ? : Results of a Survey.
Abstract number :
3.100
Submission category :
Year :
2000
Submission ID :
1716
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Enrique Carrazana, Ikna Espinosa, Steve Wheeler, Juan Espinosa, Gustavo Rey, Rafael Rivas-Vasquez, Carlos Ramirez-Mejia, Neurologic Ctr of South Florida, Miami, FL.
RATIONALE: Anticonvulsants are utilized in the treatment of various neuro-psychiatric disorders which afflict women of reproductive-age. The potential teratogenicity of anticonvulsants is a concerning risk that can be reduced through proper prenatal care and folic acid administration. METHODS: We randomly conducted an anonymous survey among neurologists and psychiatrists in Dade County on their practice habits when dealing with women of reproductive age, with focus on folic acid prescribing and prenatal discussion of anticonvulsants' teratogenic risk. RESULTS: Out of 200 random and anonymous questionaires sent, 83 were received. The group was divided as follows: by specialty, 34 (41%) neurologists vs. 49 (59%) psychiatrists; by gender, 55 (66.3%) men vs. 13 (15.7%) women, 15 did not indicated their gender; by years out of training, 24 (28.9%) 1-8 yrs, 19 (22.9%) 9-16 yrs, 22 (26.5%) 17-24 yrs, 16 (19.2%) 25+ yrs. Anticonvulsants' teratogenic risk was discussed with patients by: 25/34 (73.5%) neurologists and 30/49 (61.2%) psychiatrists. Contraception methods were discussed by 22/34 (64.7%) neurologists and 23/49 (46.9%) psychiatrists. Only 2.4% of physicians prescribed contraception; patients were referred to their OB/GYN. Folic acid or a multivitamin OTC preparation was prescribed by: 21/34 (61.8%) neurologists and only 17/49 (34.7%) psychiatrists. Folic acid prescribing was significantly greater among female (75% neurologists & 67% psychiatrists), and recently trained physicians (14/24 (58.3%) 1-8 yrs vs. 8/22 (36.4%) 17-24 yrs out of residency). CONCLUSIONS:Despite established recommendations to use folic acid for reduction of anticonvulsants' teratogenic risk in women of reproductive-age, our survey suggest that these are not being followed by a sizeable group of physicians; placing patients at risk. Education on anticonvulsants' teratogenic risks and the need for proper prenatal care (folic acid) should target not only epileptologists, but all other specialties which are currently prescribing anticonvulsants for a wide variety of neuro-psychiatric conditions.