Abstracts

Rationale: Outcomes in women with epilepsy and pregnancy are based upon national and international registries though most have a higher predominance of Caucasian or Asian heritage ethnicities. There is a dearth of information on pregnancy and fetal outcomes in African American (AA) women with epilepsy (WWE). Antiepileptic drugs (AED) have diverse pharmacokinetic (pk) properties with variability not only during pregnancy but has also been shown to be influenced by ethnicity. We reviewed AED use and pregnancy outcomes in a highly predominant AA population of WWE at a tertiary epilepsy center. Methods: We performed a retrospective chart review of WWE who were pregnant seen in the Comprehensive Epilepsy Center in Detroit, Michigan, from August 2013 through March 2019. We collected patient demographics including age, ethnicity, and duration of seizures at time of pregnancy, use of preconception folic acid, AEDs, seizure frequencies, pregnancy complications, and fetal outcomes. We descriptively analyzed the data in the total population and then in our AA population. Results: Our cohort had a total of 98 WWE with 104 pregnancies of which AA WWE comprised 77.5% of the cohort and 22% included a majority of Caucasians and other ethnicities. The average duration of epilepsy at time of pregnancy was 10.8 years (range 0-32 years) in the total cohort and 11 years in AA cohort. In the total cohort, 72% did not take preconception folic acid vs. 76% in the AA cohort. Unplanned pregnancies consisted of 80% and 83% of the total and AA cohorts, respectively.In the entire group taking AED at any point during pregnancy (n = 82), the most commonly used AEDs were levetiracetam (LEV) in 67%, lamotrigine (LAM) in 12% and 5% on lacosamide (LAC). The other AEDs used were oxcarbazepine (OXC) and phenytoin (PHT). Seventy-three percent of the total cohort was taking monotherapy. Amongst the AA cohort taking AEDs at any point during pregnancy (n = 62), 46 (74%) patients were on monotherapy. The most common AED was LEV (66%), LAM (11%) and LAC (5%). One patient was exposed to valproic acid briefly in the first trimester during an episode of status epilepticus.Premature delivery occurred exclusively in the AA WWE cohort of which five patients were on monotherapy LEV (n =3) or OXC and one with combination LEV and LAM. Spontaneous abortions occurred in one AA patient who was on levetiracetam. The only major congenital malformation (carbamazepine) in the cohort also occurred in an AA woman taking carbamazepine. There were two cases of small for gestational age infants (monotherapy OXC and LEV) and one intrauterine growth retardation (LEV).Patients who took pre-conception folic acid of at least 1 mg per day did not have poor pregnancy or fetal outcomes in our entire cohort. Conclusions: This study is important as it closely looks at a highly predominant population of AA WWE presenting during pregnancy. Despite the overall safety profile of newer AEDs reported in national registries, our cohort of mostly AA WWE showed slightly more adverse pregnancy and fetal outcomes which could be due to the low use of pre-conception folic acid use and higher incidence of unplanned pregnancies. Medical provider and patient education is essential in planning pregnancies and prescribing folic acid as AA WWE may be exposed to slightly higher risks of complications in pregnancy than reported in existing national registries. Funding: No funding