Folic Acid Prescribing and Reproductive Counseling Practices of Child Neurologists for Women With Epilepsy

Abstract

Background: Women with epilepsy (WWE) experience stigma related to reproductive health. Pediatric neurologists are often uncomfortable providing age-appropriate reproductive health counseling (RHC) and prescribing folic acid (FA). We studied RHC and FA prescribing practices for child neurologists and provide a literature review for FA dosing maximizing benefit for WWE and their children. Methods: We performed a retrospective cross-sectional study of RHC and FA prescribing by child neurologists at our center for 227 consecutive WWE from January to June 2022. We studied patient age, teratogenic risk of antiseizure medications (ASMs), number of ASMs, presence/absence of intellectual disability (ID), and physician board certification. ASM teratogenic risk was determined utilizing the North American Antiepileptic Drug Pregnancy Registry (NAADPR) database with ≥2.5% threshold of major malformation for high risk, <2.5% for low risk, and no NAADPR data for unknown risk. Results: Pediatric neurologists inconsistently prescribe FA (11%) and document RHC (10%). WWE on valproic acid receive FA more often (31% vs 9.6%, P = 0.004, χ2 = 8.28) but similar RHC to WWE on other ASMs (P = 0.080, χ2 = 3.06). Epileptologists do not prescribe FA more than general neurologists (P = 0.65, χ2 = 0.19), and general neurologists document RHC more often (18% vs 4%, P = 0.00047, χ2 = 4.21). WWE aged 16-18 years receive RHC more than WWE aged 12-15 years (12.7% vs 10.5%, P = 0.025, χ2 = 4.96) with no difference in FA prescriptions (P = 0.60, χ2 = 0.27). Patients with ID receive FA less often (6% vs 15%, P = 0.035, χ2 = 4.44) with no difference in RHC (P = 0.29, χ2 = 1.09). Conclusions: We quantify a significant gap in care for WWE to facilitate quality improvement initiatives. Preconceptional FA 1 mg orally daily seems appropriate for WWE with present knowledge.