Authors :
Mercedes Jacobson, MD – Lewis Katz School of Medicine
Presenting Author: Ada Del Pozo, MPH – Lewis Katz School of Medicine
Taylor Clark, CRNP, MBA DNP – Lewis Katz School of Medicine
Rationale:
Women with Epilepsy (WWE) account for 0.3% to 0.5% of all pregnancies in the U.S. (1) WWE are at an increased risk for pregnancy complications, perinatal morbidity, perinatal mortality (2), and reduction or discontinuation of prescribed anti-epileptic medications (AEDs) (3). The purpose of this investigation was to describe the clinical and obstetrics characteristics of pregnant WWE so that we can develop programs tailored to the needs of this community.
Methods:
This retrospective study (n=7) was conducted from July 2024- June 2025 at an academic medical center in North Philadelphia. Neurological and Obstetric data were obtained through review of the electronic medical record. Patients without epilepsy or functional non-epileptic seizures were excluded.Results:
Mean age of the cohort is 29 years old with standard deviation of 6.87. 71% were Medicaid recipients. 43% of the group received education prior to pregnancy on folic acid, ASM management and potential complications, but only 28.6% took folic acid prior to pregnancy. Less than half, 42.9% of our group were established neurology patients prior to pregnancy, 28.6% have intellectual disability, 30% reported depression. Poor medication adherence was reported in 40%. Absence of a support system was reported in 43%. 70% were English language competent. Prior pregnancy complications were noted in 2 of 7.
Conclusions:
Given the size of the OB program in our community and the known incidence of epilepsy in pregnant people, 12 or more pregnant WWE would be expected but only 7 were referred. In this cohort, 42.9% of pregnant WWE were seen by a neurologist prior to becoming pregnant; they continued to be compliant with neurology follow-up throughout pregnancy. The majority of pregnant WWE referred to neurology at any point in their pregnancy adhered to ASMs. Based on this work, safety net hospitals must construct models of care that recognize that pregnant WWE may NOT have had pre-conceptional counseling. This population requires expedited referrals from OB to neurology, and epilepsy management education. Clinical models focusing on the medical and social constraints of this population need to be implemented to improve access to the epilepsy center for pregnant WWE and WWE of reproductive age to insure best pregnancy outcomes in the future.
1. MacDonald SC, Bateman BT, McElrath TF, Hernández-Díaz S. Mortality and Morbidity During Delivery Hospitalization Among Pregnant Women With Epilepsy in the United States. JAMA Neurology. 2015;72(9):981. doi:https://doi.org/10.1001/jamaneurol.2015.1017
2. Mazzone PP, Hogg KM, Weir CJ, Stephen J, Bhattacharya S, Chin RFM. Comparison of Perinatal Outcomes for Women With and Without Epilepsy: A Systematic Review and Meta-analysis. JAMA neurology. 2023;80(5):484-494. doi:https://doi.org/10.1001/jamaneurol.2023.0148
3. Williams J, Myson V, Steward S, et al. Self-discontinuation of antiepileptic medication in pregnancy: detection by hair analysis. Epilepsia. 2002;43(8):824-831. doi:https://doi.org/10.1046/j.1528-1157.2002.38601.x