Abstracts

This is a Late Breaking abstract

Rationale: To understand the knowledge, attitudes, and practices of healthcare providers regarding reproductive healthcare for people with epilepsy of gestational capacity (PWEGC).

Methods: A market research firm recruited participants from a nationally representative healthcare provider panel to complete an online survey. Questions were based in findings from qualitative interviews with providers and review by content experts. Participant groups were compared by chi-square analysis.

Results: A total of 401 healthcare providers responded to the survey (162 neurologists, 113 primary care physicians (PCPs), and 126 obstetrician-gynecologists (OBGYNs)._x000D_ _x000D_ Knowledge: Less than half of respondents are aware that only some antiseizure medications impact contraceptive efficacy (Table 1). About two-thirds to three-quarters of respondents believe that valproic acid is among ASMs with higher teratogenic risk and that levetiracetam is among ASMs with lower teratogenic risk. About two-thirds of respondents believe that pregnancy causes increased seizures. Less than half of neurologists and PCPs believe breastfeeding is very safe for PWEGC, compared with nearly three-quarters of OBGYNs (p < 0.05)._x000D_ _x000D_ Attitudes: Forty-nine percent of neurologists, 20% of PCPs, and 41% of OBGYNs are extremely/very comfortable treating PWEGC who are pregnant (p < 0.05). Seventy-four percent of neurologists believe that pregnancy planning is important for PWEGC with well-controlled epilepsy, compared with 80% of PCPs and 94% of OBGYNs (p < 0.05). Nearly all respondents believe that pregnancy planning is important for PWEGC with poorly controlled epilepsy. Sixty-four percent of neurologists believe that ASM tapering is the most important topic to discuss with PWEGC post-partum; 74% of PCPs and 90% of OBGYNs believe that general post-partum care is most important._x000D_ _x000D_ Practices: Forty percent of neurologists begin to discuss pregnancy planning with PWEGC when they start considering pregnancy, compared with 28% at epilepsy diagnosis, 22% with onset of sexual activity, and the remainder at other times (Table 2). Less than a quarter of PCPs and OBGYNs discuss pregnancy planning with PWEGC at epilepsy diagnosis. Fifty-six percent of neurologists discuss using contraception with PWEGC, compared with 74% of PCPs and 82% of OBGYNs (p < 0.05). Eighty-five percent of neurologists recommend folate supplementation to PWEGC who are trying to conceive, compared with 90% of PCPs and 98% of OBGYNs (p < 0.05). About a third of neurologists and PCPs monitor ASM levels monthly during pregnancy; about half do so every 1 to 3 months._x000D_