Abstracts

How Perceptions of Risk Impact Reproductive Decision Making for Women with Epilepsy

Abstract number : 1.358
Submission category : 4. Clinical Epilepsy / 4E. Women's Issues
Year : 2024
Submission ID : 882
Source : www.aesnet.org
Presentation date : 12/7/2024 12:00:00 AM
Published date :

Authors :
Presenting Author: Chloe Hill, MD, MS – University of Michigan

Chun Chieh Lin, PhD, MBA – The Ohio State University
Shriya Suresh, MD – University of Michigan
Stephanie Shatzman, MD – University of Michigan
Nishad Shaheid, MD – OhioHealth Physician Group
Sung Hyun Seo, MD – University of Michigan
Linda Selwa, MD – University of Michigan
Temenuzhka Mihaylova, MD, PhD – University of Michigan

Rationale: There are many important considerations for women with epilepsy of reproductive potential. Antiseizure medications can impact contraceptive options, be teratogenic, and have neurodevelopmental effects. Seizures and antiseizure treatment can impact maternal health. While there are guidelines to promote counseling of women with epilepsy about reproductive issues, there is little known regarding how such considerations impact perceptions of reproductive risk and decision-making.

Methods: In this project, we first implemented a quality improvement survey with the goal of better understanding individual perceptions of reproductive health to improve patient care. The survey included statements/questions for patients to respond to including: 1) Fear of antiseizure medication-related birth defects (teratogenicity) affects or affected my decision for having children, and 2) Fear of having a child with epilepsy/seizures affects or affected my decision for having children. This survey was sent via electronic health record portal to women aged 21-45 years with an encounter with a primary diagnosis of epilepsy in the last five years. We then completed a research study and assessed responses across the full cohort, excluding patients without a history of epilepsy, with PNES only, or with severe cognitive impairment/survey completion by a proxy.

Results: We received responses from 267 of 842 patients who were sent the survey; after exclusion criteria were applied there were 233 participants. The median age was 32 (interquartile range 27-38). The majority were white (86%); 8% were Black and 3% were Asian. Almost half (48%) were seizure free at the time of the survey; 42% had drug-resistant epilepsy at the time of the survey. When asked about fear of antiseizure medication teratogenicity, 33% reported this impacted decisions about having children “very much”, 34% reported this impacted decisions about having children “a little”, and 33% reported this impacted decisions about having children “not at all”. When asked about fear of having a child with epilepsy/seizures, 24% reported this impacted decisions about having children “very much”, 30% reported this impacted decisions about having children “a little”, and 44% reported this impacted decisions about having children “not at all”.

Conclusions: There were a range of responses to questions about how perception of risk impacted reproductive decisions. These findings suggest that is it important for providers to elicit an individual patient’s perceptions, priorities, and preferences to optimize counseling and treatment plan with consideration to reproductive decision making.

Funding: CE Hill is funded by K23NS126495.

Clinical Epilepsy