203687 Reproductive healthcare for women with epilepsy: Continuing challenges and concerns

Tuesday, November 10, 2009: 8:45 AM

Ashley Graboski-Bauer, MPH, CHES , Department of Health Science, MSC 3HLS, New Mexico State University, Las Cruces, NM
Thriveni Reddy, MBBS , Department of Health Science, MSC 3HLS, New Mexico State University, Las Cruces, NM
Nour Abdo, BVM , Department of Health Science, MSC 3HLS, New Mexico State University, Las Cruces, NM
Robert W. Buckingham, Dr PH , Department of Health Science, MSC 3HLS, New Mexico State University, Las Cruces, NM
Kiran Sapkota, MS , Department of Health Science, New Mexico State Univesity, Las Cruces, NM
Saran Kumar Rai, BDS , Department of Health Sciences and Social Services, New Mexico State University, Las Cruces, NM
  
Introduction

Epilepsy affects 3% of Americans by age 75. Epilepsy management requires continuous medication, for example, with enzyme-inducing anti-epileptic drugs (EIAEDs). EIAED treatment poses unique reproductive health concerns for women with epilepsy (WWE). When hormonal contraception (HC) and EIAEDs are taken concomitantly, EIAED efficacy is decreased by up to 70% and HC efficacy by up to 20%. Paradoxically, the teratogenic potential of anti-epileptic drugs (AEDs) necessitates that WWE carefully plan their pregnancies, making it is essential that healthcare providers competently address the reproductive needs of WWE.

Methods

Published data assessing provider and patient knowledge and behavior pertaining to the reproductive needs of WWE was collected from a variety of sources. Analysis reviewed the combined results of these studies to identify knowledge deficits and discrepancies between knowledge and behavior.

Results

A significant portion of WWE of child-bearing age report having never received information regarding AEDs and contraception. Similar proportions of physicians report that they are unaware or unsure of the specifics of EIAED/HC interactions. Of physicians claiming moderate familiarity with HC/AED interactions, an insignificant portion are able to actually demonstrate such knowledge or report appropriately altering their clinical practice.

Conclusion

A distressing percentage of WWE and healthcare providers remain ignorant of EIAED/HC interactions. Therefore, WWE are not receiving competent reproductive healthcare and risk unplanned pregnancy and inadvertent teratogen exposure. In light of the failure of medical professionals to adhere to professional or institutional guidelines dictating the details of competent reproductive care for WWE, a multifaceted patient/public education campaign is warranted.

Learning Objectives:
1. Explain the unique reproductive healthcare needs of women with epilepsy; 2. Discuss current inadequacies in provider knowledge and behavior pertaining to the reproductive needs of women with epilepsy; and 3. Describe patient-oriented interventions for addressing the aforementioned issues regarding the reproductive needs of women with epilepsy.

Keywords: Women's Health, Reproductive Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Personal experience as to the obstacles faced by women with epilepsy seeking quality reproductive healthcare inspired this research. I utilized my training as a CHES and an MPH, as well as my background in anthropology and scientific and technical writing to evaluate current data and develop relevant interventions.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Improving Women’s Reproductive Health Care within Diverse Communities
See more of: Women's Caucus