Abstracts

Pre-pregnancy planning is important for women with epilepsy to optimize fetal outcome. In addition, women with epilepsy experience higher pregnancy-related risks than their healthy peers. Published guidelines recommend highly effective contraception; however, no published data describes contraceptive practices in this population., We conducted a cross-sectional questionnaire study among a convenience sample of reproductive-age women (18 to 44) with epilepsy attending outpatient clinics at an urban, academic medical center. Questionnaires were administered at 3 clinics. Two included patients in a private office with predominantly commercial insurance and 1 was a multi-provider clinic of mostly Medicaid insurance. Our questionnaire assessed demographics, reproductive history, antiepileptic drug use, sexual behavior, and contraceptive use. The questionnaire was offered in both English and Spanish and conducted in a private area., We approached 425 women to obtain 148 (35%) completed questionnaires; many were excluded due to age (n=198). Participants had a mean age of 32 years (SD [plusmn] 8), 32% spoke Spanish and 32% described themselves as Hispanic. Insurance included commercial (55%), Medicaid/Medicare (41%), and self-pay (6%). Participants reported a wide range of educational attainment and income.
Fifty-five percent (n=78) reported having vaginal intercourse in the last 30 days. Of these sexually active women, 59 (76%) used contraception, 11 (14%) were pregnant, and 2 (3%) sought pregnancy. Contraceptive methods included male condoms (n=21, 36%), withdrawal (n=18, 31%), oral contraception (n=16, 27%), male or female sterilization (n=10, 17%) , patch (n=3, 5%), rhythm (n=3, 5%), intrauterine device (n=1, 2%), depo-provera (n=1, 2%), and other (n=11, 19%). Some women used multiple methods. Of those using hormonal methods (oral contraception, patch, depo-provera) (n=21), 6 (29%) concomitantly took an enzyme inducing antiepileptic drug with known increasing susceptibility to pregnancy. Women reported 181 pregnancies and 91 (50%) were unplanned., In this sample, many women with epilepsy at risk for getting pregnant rely on low-efficacy contraceptive methods. Similar to the general population, 50% of their pregnancies were unplanned. These findings illustrate the need for continued education of women with epilepsy regarding effective contraception.,