Abstracts

Rationale: Antiepileptic drugs (AEDs) may impact reproductive health. Certain AEDs are teratogens and some induce the hepatic p450 system increasing metabolism of contraceptive steroids and decreasing effectiveness. Published data reveal confusion regarding these effects among neurologists and obstetrician gynecologists. Whether women with epilepsy understand the effects of prescribed AED on fetal development and hormonal contraception remains unknown. Our objective was to explore knowledge regarding the reproductive health effects of AED therapy among reproductive-age women with epilepsy. Methods: We conducted a cross-sectional questionnaire study in women aged 18-44 with epilepsy. Participants were recruited from the Columbia Comprehensive Epilepsy Center. We collected information about demographic characteristics, reproductive history, and current pharmacotherapy. We assessed knowledge about teratogenicity by asking “Do you know if (AED)affects the development of a baby during pregnancy?” and coded responses as bad effect, good effect, no effect, unknown effect, or doesn’t know. To assess knowledge of interactions with hormonal contraception we asked “Do you know if (AED) changes how well birth control pills work?”and coded responses as bad effect (decreases effectiveness), no effect, or doesn’t know. Results: Participants’(n=148) mean age was 32 years (SD ± 8); 32% spoke Spanish and described themselves as Hispanic. Participants reported a wide range of educational attainment and income. Among the 148 women, 56.9% reported currently receiving AED monotherapy. Among all AEDs prescribed (monotherapy or in combination), 31.7% were prescribed lamotrigine, 16.3% levetiracetam, 10.9% carbamazepine, and 5.4% valproate. Ten other AEDs each accounted for less than 10% of total prescribed. For FDA Category D AEDs, 40% of subjects were unaware of potential teratogenic effects, 44% indicated a negative effect, 6% no effect, and 6% a good effect on fetal development. For Category C AEDs, 45% did not know, 29% indicated a negative effect, 16% no effect, 6% unknown effect, and 2% a good effect. AEDs potentially increasing hormonal contraceptive metabolism were prescribed 66 times. This interaction was correctly cited in 32% of women taking them. Participants did not know in 65% and 3% said no interaction. AEDs with no effect on contraceptive metabolism were prescribed 138 times; 26% incorrectly cited an interaction, 47% did not know, and 25% correctly said no interaction. Conclusions: Reproductive aged women with epilepsy at an academic epilepsy center were most commonly prescribed lamotrigine and levetiracetam. Valproate accounted for less than 10% of prescribed AEDs. Many women prescribed Category C (45%) or Category D (40%) AEDs were unaware of potential teratogenic effects. Among those prescribed an AED increasing hormonal contraceptive metabolism, the majority (65%) were unaware of a decrease in hormonal contraceptive efficacy. Additional educational efforts should be promoted to increase knowledge of potential teratogenesis and interaction with hormonal forms of contraception.