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Hoeltzenbein M, Bartz I, Fietz AK, Lohse L, Onken M, Dathe K, Schaefer C. Antiepileptic treatment with levetiracetam during the first trimester and pregnancy outcome: An observational study. Epilepsia 2024; 65:26-36. [PMID: 37857460 DOI: 10.1111/epi.17800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Levetiracetam is increasingly used in pregnant women with epilepsy. Although teratogenic effects have not been observed so far, data on the risks of spontaneous abortion and major birth defects are still limited, especially for the frequently used dual therapy of levetiracetam and lamotrigine. Our primary aim was to analyze rates of major birth defects and spontaneous abortion after maternal levetiracetam treatment. METHODS This was a cohort study based on pregnancies recorded by the Embryotox Center from 2000 to 2017. Outcomes of prospectively ascertained pregnancies with first trimester levetiracetam monotherapy (n = 221) were compared to pregnancies with lamotrigine monotherapy for epilepsy (n = 469). In addition, all pregnancies with levetiracetam (n = 364) exposure during the first trimester were analyzed in comparison to a nonexposed cohort (n = 729). Pregnancies with the most frequently used combination therapy comprising levetiracetam and lamotrigine (n = 80) were evaluated separately. RESULTS There was no significantly increased risk of major birth defects or of spontaneous abortions after first trimester exposure to levetiracetam. Birth weight of male neonates was significantly lower after levetiracetam monotherapy compared to lamotrigine monotherapy. Dual therapy with levetiracetam and lamotrigine resulted in a significantly increased risk of spontaneous abortion (adjusted hazard ratio = 3.01, 95% confidence interval [CI] = 1.43-6.33) and a nonsignificant effect estimate for major birth defects (7.7%, n = 5/65, adjusted odds ratio = 1.47, 95% CI = .48-4.47) compared to a nonexposed cohort. SIGNIFICANCE Our study confirms the use of levetiracetam as a suitable antiepileptic drug in pregnancy. The lower birth weight of male neonates after maternal levetiracetam monotherapy and the unexpectedly high risk of spontaneous abortion and birth defects after dual therapy with levetiracetam and lamotrigine require further investigation.
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Affiliation(s)
- Maria Hoeltzenbein
- Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Insa Bartz
- Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anne-Katrin Fietz
- Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lukas Lohse
- Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marlies Onken
- Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katarina Dathe
- Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christof Schaefer
- Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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Shawahna R, Zaid L. Caring for women with epilepsy in Palestine: A qualitative study of the current status. Epilepsy Behav 2022; 130:108689. [PMID: 35398722 DOI: 10.1016/j.yebeh.2022.108689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This qualitative study was conducted to explore the current status of caring for women with epilepsy (WWE) in the Palestinian healthcare system. METHODS This study used an explorative qualitative design. A purposive sampling technique was used to recruit the participants. Semi-structured in-depth interviews were conducted with neurologists (n = 6), gynecologists (n = 5), psychiatrists (n = 3), an internist (n = 1), and clinical pharmacists (n = 5). The interpretive description methodology was used to thematically analyze the qualitative data. RESULTS A total of 745 min (12.4 h) of interview time were analyzed. The qualitative data collected in this study were categorized under 3 major themes and multiple subthemes. The 3 major themes were: (1) diagnosis and care for patients with epilepsy, (2) general issues in caring for patients with epilepsy, and (3) consideration of women's issues in the pharmacotherapy of epilepsy. Formally adopted protocols/criteria for the diagnosis and care for WWE were lacking. CONCLUSION Findings of this qualitative study showed a need to formally adopt uniform guidelines that can guide the diagnosis and care of WWE in the Palestinian healthcare system. The findings of this study might be informative to healthcare providers, decision-makers in healthcare authorities, WWE, and patient advocacy groups who could be interested in improving and benchmarking healthcare services provided to WWE. Future studies are still needed to quantitatively measure adherence to the international guidelines in caring for WWE.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
| | - Lina Zaid
- Master of Pharmacology Program, Faculty of Graduate Studies, An-Najah National University, Nablus, Palestine
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Contraception and Reproductive Health Care for Adolescent and Young Adult Women with Epilepsy. J Pediatr 2022; 241:229-236. [PMID: 34728232 DOI: 10.1016/j.jpeds.2021.10.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/16/2021] [Accepted: 10/27/2021] [Indexed: 11/21/2022]
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Abstract
PURPOSE OF REVIEW Seizure disorders are the most frequent major neurologic complication in pregnancy, affecting 0.3% to 0.8% of all gestations. Women of childbearing age with epilepsy require special care related to pregnancy. This article provides up-to-date information to guide practitioners in the management of epilepsy in pregnancy. RECENT FINDINGS Ongoing multicenter pregnancy registries and studies continue to provide important information on issues related to pregnancy in women with epilepsy. Valproate poses a special risk for malformations and cognitive/behavioral impairments. A few antiseizure medications pose low risks (eg, lamotrigine, levetiracetam), but the risks for many antiseizure medications remain uncertain. Although pregnancy rates differ, a prospective study found no difference in fertility rates between women with epilepsy who were attempting to get pregnant and healthy controls. During pregnancy, folic acid supplementation is important, and a dose greater than 400 mcg/d during early pregnancy (ie, first 12 weeks) is associated with better neurodevelopmental outcome in children of women with epilepsy. Breastfeeding is not harmful and should be encouraged in women with epilepsy even when they are on antiseizure medication treatment. SUMMARY Women with epilepsy should be counseled early and regularly about reproductive health. Practitioners should discuss the risks of various obstetric complications; potential anatomic teratogenicity and neurodevelopmental dysfunction related to fetal antiseizure medication exposure; and a plan of care during pregnancy, delivery, and postpartum. Women with epilepsy should also be reassured that the majority of pregnancies are uneventful.
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Affiliation(s)
- Yi Li
- Clinical Assistant Professor of Neurology and Neurological Sciences, Stanford University, Palo Alto, California
| | - Kimford J. Meador
- Stanford, University School of Medicine, Stanford Neuroscience Health, Center, 213 Quarry Rd, MC 5979, Palo Alto, CA 94304
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Marxer CA, Rüegg S, Rauch MS, Panchaud A, Meier CR, Spoendlin J. A review of the evidence on the risk of congenital malformations and neurodevelopmental disorders in association with antiseizure medications during pregnancy. Expert Opin Drug Saf 2021; 20:1487-1499. [PMID: 34128743 DOI: 10.1080/14740338.2021.1943355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: The majority of women with epilepsy require treatment with antiseizure medications (ASM) throughout pregnancy. However, in utero exposure to several ASM has been associated with an increased risk of congenital malformations and/or neurodevelopmental disorders (CM/NDD) in the child, but observational evidence is methodologically heterogeneous.Areas covered: We critically evaluate current evidence on the risk of CM/NDD in children of women with epilepsy after in utero exposure to different ASM. We highlight characteristics of different data sources and discuss their benefits and drawbacks. This review includes evidence published before December 2020.Expert opinion: Given the lack of randomized controlled trials, evidence on in utero safety of ASM originates from methodologically heterogeneous post-marketing observational studies based on registries, prospective cohorts, and large electronic health databases. It has been clearly demonstrated that valproate is associated with a high risk of CM/NDD, whereas lamotrigine and levetiracetam are relatively safe. However, evidence is less explicit for other ASM. Reported risks vary depending on the size and origin of the underlying study population, the definition of exposure and outcomes, and other aspects of the study design. Increased collaboration between data sources to increase sample size is desirable.
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Affiliation(s)
- Carole A Marxer
- Hospital Pharmacy, University Hospital Basel, Basel, Switzerland.,Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Stephan Rüegg
- Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Marlene S Rauch
- Hospital Pharmacy, University Hospital Basel, Basel, Switzerland.,Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Alice Panchaud
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Switzerland.,Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute for Pharmaceutical Sciences of Western Switzerland, Switzerland
| | - Christoph R Meier
- Hospital Pharmacy, University Hospital Basel, Basel, Switzerland.,Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Boston Collaborative Drug Surveillance Program, Lexington, MA, United States
| | - Julia Spoendlin
- Hospital Pharmacy, University Hospital Basel, Basel, Switzerland.,Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
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NEJAD FATEMEKHAJOEI, SHAHRAKI KATAYOUNALIDOUSTI, NEJAD PARVINSALEHI, MOGHADDAM NOSHIRVANKHEZRI, JAHANI YONES, DIVSALAR PARISA. The influence of mindfulness-based stress reduction (MBSR) on stress, anxiety and depression due to unwanted pregnancy: a randomized clinical trial. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E82-E88. [PMID: 34322621 PMCID: PMC8283654 DOI: 10.15167/2421-4248/jpmh2021.62.1.1691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/22/2021] [Indexed: 11/16/2022]
Abstract
Background Individuals with unwanted pregnancies often experience high levels of anxiety, stress and depression that associated with maternal-neonatal outcomes. Mindfulness training is a safe and acceptable strategy to support mental health before parturition. Purpose The main objective of present study was to evaluate the influence of eight-week application of mindfulness-based stress reduction on stress, anxiety and depression caused by unplanned pregnancy. Method In this study, 60 women with unwanted pregnancy before 32 weeks of gestational age were selected and randomly divided into two groups. Intervention group received MBSR sessions, practice at home and the recorded sound. Mental health was evaluated before intervention and at the end of the eight sessions by standard stress, anxiety and depression DASS-21 questionnaire. Data were analyzed using Chi-square, Mann-Whitney U and Wilcoxon tests. Findings In order to compare pre-test and post-test scores in each group, the Wilcoxon Test was used. The results revealed that the participants in the intervention group reported a significant decrease in mean scores of stress, anxiety and depression compared to baseline (P = 0.0). Whereas no significant decrease in mean stress, anxiety and depression score were found in control group. P-value was estimated to be 0.346, 0.212 and 0.343 respectively. Conclusions The mindfulness program has effectively reduced stress, anxiety and depression. Further research is needed to investigate the mechanisms and effects of mindfulness on maternal-neonatal outcomes.
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Affiliation(s)
- FATEME KHAJOEI NEJAD
- Nursing Research Center, Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - KATAYOUN ALIDOUSTI SHAHRAKI
- Midwifery Department, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Iran
- Correspondence: Katayoun Alidousti Shahraki, Midwifery Department, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Iran - Tel.: 09132421749 - Fax: 03431325218 - E-mail: -
| | - PARVIN SALEHI NEJAD
- Department of Midwifery, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | | | - YONES JAHANI
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran - Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - PARISA DIVSALAR
- Assistant professor of psychiatry, fellowship of psychosomatic Medicine, MD, Neuroscience Research Center, Institute of Neuropharmacology, Department of Psychiatry, School of medicine, Kerman University of Medical Sciences, Kerman, Iran
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Zhang YY, Song CG, Wang X, Jiang YL, Zhao JJ, Yuan F, Yang XA, Yang F, Jiang W. Clinical characteristics and fetal outcomes in women with epilepsy with planned and unplanned pregnancy: A retrospective study. Seizure 2020; 79:97-102. [PMID: 32460217 DOI: 10.1016/j.seizure.2020.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/02/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To compare the antiepileptic drug (AED) treatment patterns, seizure control, and folic acid supplementation between planned and unplanned pregnancy in women with epilepsy (WWE) and to investigate the effects of planned pregnancy on fetal outcomes. METHODS A prospectively collected database including WWE with pregnancy from Feb 2010 to Dec 2018 was retrospectively analyzed. Planned pregnancy was defined as WWE being regularly supervised by epileptologists from the time of intended pregnancy until delivery. Clinical characteristics and fetal outcomes were compared between the planned and unplanned pregnancy groups. Logistic regression was used to identify modifiable factors associated with adverse fetal outcomes. RESULTS A total of 188 planned pregnancies and 289 unplanned pregnancies were enrolled in our study. Among planned pregnancies, 66.0 % took AED monotherapy, and 32.4 % received polytherapy. Among unplanned pregnancies, 58.1 % didn't take AEDs, 28.0 % took monotherapy, and 12.8 % received polytherapy. The planned pregnancies had less generalized tonic-clonic seizures (P = 0.002) and higher proportion of being seizure-free (41.0 % vs. 22.8 %; P <0.001). All planned pregnancies took folic acid while 39.8 % of unplanned pregnancies never took it (P <0.001). The planned pregnancies had less rates of induced abortions (2.7 % vs. 13.5 %; P <0.001), preterm births (3.3 % vs. 20.4 %; P <0.001), and major congenital malformations (1.6 % vs. 7.5 %; P = 0.016). Pregnancy planning was independently associated with adverse fetal outcomes (adjusted OR, 0.14; 95 % CI, 0.08-0.27; P <0.001). CONCLUSION Planned pregnancy in WWE contributes to more optimized AED pattern, better seizure control, more appropriate folic acid supplementation, and less adverse fetal outcomes.
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Affiliation(s)
- Yao-Yao Zhang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chang-Geng Song
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xuan Wang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yong-Li Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jing-Jing Zhao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Fang Yuan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xi-Ai Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Fang Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
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Sexual and reproductive healthcare for adolescent and young adult women with epilepsy: A qualitative study of pediatric neurologists and epileptologists. Epilepsy Behav 2020; 104:106911. [PMID: 31986439 DOI: 10.1016/j.yebeh.2020.106911] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this study was to explore the attitudes and practices of pediatric neurologists and epileptologists regarding sexual and reproductive healthcare for adolescent and young adult women with epilepsy (WWE). BACKGROUND Adolescent and young adult WWE have unique sexual and reproductive healthcare needs, including counseling on teratogenesis, folic acid, and interactions between contraception and antiseizure medications. There are no prior studies regarding sexual and reproductive healthcare practices of pediatric neurologists or epileptologists. DESIGN/METHODS Individual semi-structured interviews were conducted with pediatric neurologists and epileptologists regarding their attitudes, practices, and experiences with sexual and reproductive healthcare for adolescent and young adult WWE. Interviews were audio-recorded and transcribed verbatim. Qualitative analysis was conducted using a thematic analysis approach. RESULTS Six child neurologists and 10 epileptologists (44% male) participated. Major themes included the following: (1) Sexual and reproductive healthcare is important for adolescent WWE, and neurologists have a key role in providing this care. (2) Sexual and reproductive healthcare should be comanaged with a primary care provider or women's health provider although neurologists have significant concerns regarding comanagement. (3) There is wide variability in sexual and reproductive healthcare practice among pediatric neurologists and epileptologists. Important subthemes included parent education and differences in sexual and reproductive healthcare practices for women with intellectual disabilities. (4) Many systemic and interpersonal barriers exist to delivering sexual and reproductive healthcare to adolescent and young adult WWE. Important barriers included limited time; provider, patient, or family discomfort; and lack of necessary knowledge or expertise. (5) Providers desire standardization of sexual and reproductive healthcare for adolescent WWE along with patient and provider education. CONCLUSION This is the first study to assess attitudes and practices of pediatric neurologists and epileptologists regarding sexual and reproductive healthcare for adolescent and young adult WWE. Our findings suggest that there is a need for development of improved systems for sexual and reproductive healthcare delivery and comanagement for adolescent and young adult WWE. Providers identified many barriers and facilitators that might serve as the basis for interventions to improve care.
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Meador KJ, Pennell PB, May RC, Brown CA, Baker G, Bromley R, Loring DW, Cohen MJ. Effects of periconceptional folate on cognition in children of women with epilepsy: NEAD study. Neurology 2019; 94:e729-e740. [PMID: 31871217 DOI: 10.1212/wnl.0000000000008757] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/21/2019] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Emerging evidence suggests potential positive neuropsychological effects of periconceptional folate in both healthy children and children exposed in utero to antiseizure medications (ASMs). In this report, we test the hypothesis that periconceptional folate improves neurodevelopment in children of women with epilepsy by re-examining data from the Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) study. METHODS The NEAD study was an NIH-funded, prospective, observational, multicenter investigation of pregnancy outcomes in 311 children of 305 women with epilepsy treated with ASM monotherapy. Missing data points were imputed with Markov chain Monte Carlo methods. Multivariate analyses adjusted for multiple factors (e.g., maternal IQ, ASM type, standardized ASM dose, and gestational birth age) were performed to assess the effects of periconceptional folate on cognitive outcomes (i.e., Full Scale Intelligence Quotient [FSIQ], Verbal and Nonverbal indexes, and Expressive and Receptive Language indexes at 3 and 6 years of age, and executive function and memory function at 6 years of age). RESULTS Periconceptional folate was associated with higher FSIQ at both 3 and 6 years of age. Significant effects for other measures included Nonverbal Index, Expressive Language Index, and Developmental Neuropsychological Assessment Executive Function at 6 years of age, and Verbal Index and Receptive Language Index at 3 years of age. Nonsignificant effects included Verbal Index, Receptive Index, Behavior Rating Inventory of Executive Function-Parent Questionnaire Executive Function, and General Memory Index at 6 years of age, and Nonverbal Index and Expressive Index at 3 years of age. CONCLUSIONS Use of periconceptional folate in pregnant women with epilepsy taking ASMs is associated with better cognitive development. CLINICALTRIALSGOV IDENTIFIER NCT00021866.
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Affiliation(s)
- Kimford J Meador
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA.
| | - Page B Pennell
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA
| | - Ryan C May
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA
| | - Carrie A Brown
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA
| | - Gus Baker
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA
| | - Rebecca Bromley
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA
| | - David W Loring
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA
| | - Morris J Cohen
- From the Department of Neurology and Neurological Sciences (K.J.M.), Stanford University, CA; Department of Neurology (P.B.P.), Brigham and Women's Hospital, Harvard Medical School, Boston; The Emmes Corporation (R.C.M., C.A.B.), Rockville, MD; Walton Centre for Neurology & Neurosurgery (G.B.), University of Liverpool, Merseyside; Division of Evolution and Genomic Science (R.B.), School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Departments of Neurology and Pediatrics (D.W.L.), Emory University, Atlanta; and Pediatric Neuropsychology International (M.J.C.), Augusta, GA
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Herzog AG, Mandle HB, MacEachern DB. Prevalence of highly effective contraception use by women with epilepsy. Neurology 2019; 92:e2815-e2821. [PMID: 31101739 DOI: 10.1212/wnl.0000000000007581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/08/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine (1) the proportion of women with epilepsy (WWE) at risk of unintended pregnancy who use highly effective contraception, (2) demographic predictors, and (3) folic acid (FA) use. METHODS These cross-sectional data come from 311 US WWE, 18-47 years, who participated in the Epilepsy Birth Control Registry (EBCR) web-based survey in 2017. They provided demographic, epilepsy, antiepileptic drug (AED), contraceptive, and FA data. We report frequencies of highly effective contraception use and use logistic regression to determine demographic predictors. We report the proportion who take FA. RESULTS A total of 186 (59.8%) of the 311 WWE were at risk of unintended pregnancy. A total of 131 (70.4%) used a highly effective contraceptive category; 55 (29.6%) did not. An additional 13 (7.0%) used a combination of generally effective hormonal contraception with an enzyme-inducing AED, which poses increased risk of unintended pregnancy. Overall, 68 (36.6%) of the 186 WWE at risk did not use highly effective contraception. Increasing income (p = 0.004) and having insurance (p = 0.048) were predictors of highly effective contraception. A total of 50.0% took FA supplement. There was no significant difference in relation to the use or lack of use of highly effective contraception. CONCLUSION A total of 36.6% of WWE in the EBCR did not use highly effective contraception and 50.0% did not take FA in 2017 despite the important negative consequences of unintended pregnancy on pregnancy outcomes. There is a need for more readily available information and counseling on safe and effective contraception and FA use for this community.
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Affiliation(s)
- Andrew G Herzog
- From the Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Hannah B Mandle
- From the Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, MA
| | - Devon B MacEachern
- From the Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, MA
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