Epilepsy, Intellectual Disability, and Contraception Among Medicaid Beneficiaries
Abstract number :
2.287
Submission category :
4. Clinical Epilepsy / 4E. Women's Issues
Year :
2025
Submission ID :
976
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Elizabeth Harrison, MD, MS – University of Virginia
Abrar Al-Faraj, MD – Boston Medical Center, BU Chobanian and Avedisian school of Medicine, Boston, MA USA
Erin Friel, BPhil – University of Pittsburgh
Wesley Kerr, MD, PhD – University of Pittsburgh Department of Neurology
Page Pennell, MD – University of Pittsburgh
Jasmin Rivero-Guerra, n/a – University of Pittsburgh
Scott Rothenberger, PhD – University of Pittsburgh
Anumeha Sheth, MD – Hartford HealthCare Ayer neuroscience institute Comprehensive Epilepsy Center
Samuel Terman, MD, MS – University of Michigan
Nicole Woodrich, PharmD, BCPS – Cleveland Clinic
Laura Kirkpatrick, MD – University of Pittsburgh
Rationale: Little is known about whether epilepsy affects contraceptive prescriptions in the U.S, and whether such patterns are also affected by intellectual disability (ID) co-occurring with epilepsy.
Methods: We obtained Medicaid claims data for females ages 12-51 years old from 2016-2021. We excluded individuals with diagnosis codes for menopause or who were sterilized in 2016-2017. Using a validated definition of epilepsy in claims data, we identified females who met criteria for epilepsy from 2016-2017 and identified a comparison group of females enrolled in 2016-2017 who never met diagnostic criteria for epilepsy. We used ICD codes deployed in prior claims studies to determine ID diagnoses. We ascertained contraceptive prescriptions from 2018-2021. To evaluate the impact of epilepsy, ID, and their interaction on contraceptive prescription, we performed a logistic regression for prescription of any contraceptive method 2018-2021, adjusting for days enrolled, age group, U.S. region, language, race/ethnicity, and number of non-epilepsy co-morbidities determined by the Centers for Disease Control and Prevention to complicate pregnancy/contraception. We performed similar logistic regressions for prescription of individual contraceptive methods 2018-2021 among females prescribed any method of contraception. We performed Bonferroni correction to adjust for multiple comparisons.
Results: Our final sample included 207,699 females with epilepsy and 3,573,052 females without epilepsy. The median age of the epilepsy sample was 28 (IQR 20-36) and of the non-epilepsy sample was 26 (IQR 18-34). Overall, 33% of females with epilepsy only (no ID), 23% of females with ID only (no epilepsy), 33% of females with both diagnoses, and 30% of females with neither diagnosis were ever prescribed any contraceptive. In the logistic regression for contraceptive prescription, females with epilepsy were significantly more likely to be prescribed any contraceptive method than females without epilepsy (aOR 1.05, 95% CI 1.04-1.06, p< 0.0001), females with ID were significantly less likely to be prescribed any contraceptive method than females without ID (aOR 0.57, 0.56-0.58, p< 0.0001), and there was a statistically significant interaction between epilepsy and ID (aOR 1.38, 1.34-1.42, p< 0.0001). There were different patterns of prescription for specific contraceptives between females with epilepsy only, ID only, both diagnoses, and neither diagnosis, as demonstrated in Figure 1. Detailed logistic regression results are shown in Table 1.
Clinical Epilepsy