Folic Acid Prescribing and Reproductive Counseling Practices of Child Neurologists for Women with Epilepsy

Abstract

AimWomen with epilepsy (WWE) experience stigma related to reproductive health. Pediatric neurologists are often uncomfortable providing age-appropriate reproductive health counseling (RHC) and prescribing folic acid (FA). We studied RHC and FA prescribing practices for child neurologists and provide a literature review for FA dosing maximizing benefit for WWE and their children.MethodsWe performed a retrospective cross-sectional study of RHC and FA prescribing by child neurologists at our center for 227 consecutive WWE from January-June 2022. We studied patient age, teratogenic risk of antiseizure medications (ASMs), number of ASMs, presence or absence of intellectual disability (ID), and physician board certification. ASM teratogenic risk was determined utilizing the North American Antiepileptic Drug Pregnancy Registry (NAADPR) database with >2.5% threshold of major malformation for high risk, <2.5% for low risk, and no NAADPR data for unknown risk.ResultsPediatric neurologists inconsistently prescribe FA (11%) and document RHC (10%). WWE on valproic acid receive FA more often (31%vs9.6%, p=0.004,χ2=8.28) but similar RHC to WWE on other ASMs (p=0.080,χ2=3.06). Epileptologists do not prescribe FA more than general neurologists (p=0.65,χ2=0.19), and general neurologists document RHC more often (18%vs4%,p=0.00047,χ2=4.21). WWE ages 16-18 receive RHC more than WWE ages 12-15 (12.7%vs10.5%,p=0.025,χ2=4.96) with no difference in FA prescriptions (p=0.60,χ2=0.27). Patients with ID receive FA less often (6%vs15%,p=0.035,χ2=4.44) with no difference in RHC (p=0.29,χ2=1.09).ConclusionWe quantify a significant gap in care for WWE to facilitate quality improvement initiatives in prescribing FA and documenting RHC. Preconceptional FA 1 mg orally daily seems appropriate for WWE with present knowledge.

Note:
Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Interests: The authors declare that they have no conflicts of interest.

Ethical Approval Statement: This study was reviewed by the Indiana University Internal Review Board (IRB) and approved with IRB protocol #14825 with exception made for consent of subjects due to the retrospective nature of this study.

Keywords: Seizure, Epilepsy, Intellectual Disability, Folic Acid, Neural Tube Defect, Antiseizure Medication, Reproductive Counseling, Teratogenic