Abstracts

Rationale: Women with epilepsy (WWE) of child-bearing age require expertise and coordination in the treatment of epilepsy in the context of reproductive health goals. Anticonvulsants (AEDs) increase the risk of teratogenesis, and bidirectional interactions between AEDs and hormonal contraception can lead to the failure of contraceptive methods and decreased efficacy of AEDs. Despite the known risks and interactions, a significant number of WWE do not use highly effective forms of contraception (Davis et al., 2008) The majority of WWE using contraception are prescribed combined hormonal methods (CHC), and up to 89% of whom are concurrently prescribed an AED with drug-drug interaction (Bhakta et al., 2015). These practices result in 79% of WWE reporting at least one unintended pregnancy and 65% of all pregnancies classified as unintended (Herzog et al., 2017). Long-acting reversible contraception (LARC), including intrauterine devices (IUD) and etonogestrel implant, as well as depot medroxyprogesterone acetate (DMPA) provide WWE with highly effective family planning methods that avoid drug-drug interactions with AEDs to minimize the risks of reduced AED efficacy, unintended pregnancy, and potential teratogenesis. Counseling from an epileptologist specifically about highly effective contraception methods increases the rate of WWE switching to LARC (Espinera et al., 2016).  The UC Davis collaborative epilepsy and family planning gynecology clinic provides WWE access to expertise from both professions in a single visit. Following its inception, the clinic has since been able to provide LARC or DMPA in the same encounter. This investigation reviews the impact of a collaborative clinic model with same day access to LARC and DMPA on the patients’ contraception plan and initiation of methods. Methods: A retrospective review was performed of joint clinic encounters of WWE, ages 15-45 years, from 6/2014 - 5/2017 (n=64). We excluded WWE who were planning conception. Demographic data, epilepsy classification, AED prescription, and contraceptive plan before and after the clinic visit were collected. Two tailed Mann-Whitney tests were performed to evaluate the impact of contraception counseling on contraceptive plan and the impact of same day clinic availability for LARC and DMPA on initiation of methods. Results: Demographics are summarized in Table 1. Of WWE on CHC, 75% were also prescribed AEDs with potential drug-drug interaction, which decreased to 63% post visit. Contraceptive methods used prior to the clinic appointment (Figure 1) consisted of no plan/barrier methods in 61%, CHC in 25%, DMPA in 2%, and LARC in 11%. Following the encounter, contraception method was 25% for none/barrier, 30% CHC, and 28% electing for LARC with or without CHC, p-value < 0.01. Same day access to LARC and DMPA revealed a trend of increased utilization. Of those who planned for LARC or DMPA, 40% initiated their intended method when a separate encounter was required compared to 53% when same day initiation was available. Conclusions: We have previously demonstrated a significant shift to the use of highly effective contraception in a small number of WWE evaluated by both epileptologists and family planning specialist in a collaborative model clinic (Park et al., 2015). In this investigation, we observe a more significant impact in a larger population. The high rate of potential drug-drug interactions remaining even after WWE are evaluated in this clinic are likely in part from menstrual suppression. However, it highlights the need for continued careful and collaborative management. Finally, we observed a trend toward an increase in the proportion of patients electing for LARC and DMPA initiation when available on the same day joint clinic encounter. Funding: None