Latest Findings on Epilepsy and Pregnancy are not Reaching Clinical Practice
By: Fernanda Juarez Anaya
Healthcare providers have gaps in knowledge about latest research findings pertaining to reproductive health and epilepsy, suggests new research from the University of Pittsburgh School of Medicine published today in Neurology: Clinical Practice.
The report highlights that the medical community needs to improve how it keeps healthcare providers updated on new research and translates scientific findings into effective, evidence-based practices that empower patients with epilepsy to make well-informed decisions about their reproductive health.
“People living with epilepsy have a lot of concerns about their reproductive health, such as the safety of taking antiseizure medications while breastfeeding or how the drugs interact with contraceptives, and those concerns are often not being addressed properly in clinical practice,” said lead author Dr. Laura Kirkpatrick, assistant professor of pediatrics with a secondary appointment in neurology at Pitt. “They are not getting up-to-date education on these issues.”
Despite active research on the neurodevelopmental impacts of antiseizure medications during pregnancy, such as the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) and the International Registry of Antiepileptic Drugs and Pregnancy (EURAP) studies, accurate and easy-to-understand information about the latest findings seldom reaches patients and healthcare providers.
According to a survey of cisgender women with epilepsy and their healthcare providers conducted by Kirkpatrick and her team, about 40% of women reported significant concerns related to reproductive health, including questions about potential effects of antiseizure medications on fetal development and the likelihood of passing epilepsy to their children.
While nearly 40% of surveyed U.S. neurologists, primary care clinicians and obstetrician-gynecologists (OB-GYNs) reported being comfortable treating pregnant patients with epilepsy, almost 80% said that recent research findings about epilepsy and pregnancy were new to them. For example, while the majority of providers recommended folic acid supplements to patients who were trying to conceive and knew that breastfeeding is at least sometimes safe in epilepsy, less than half of all surveyed providers were aware of drug interactions between antiseizure medications and contraceptives.
Most surveyed physicians acknowledged that access to updated research could improve their clinical practices. Primary care providers in particular were less knowledgeable about the relative safety of antiseizure medications during pregnancy compared to neurologists and OB-GYNs.
Because specialty neurology services may not be universally accessible, education of primary care providers is important for increasing the quality of patient care, researchers suggest. While initiatives, such as educational series that allow primary care physicians to seek advice from specialists, aim to bridge these gaps, this study emphasizes the urgency of translating research into consistent, evidence-based care.
Notably, both women with epilepsy and healthcare providers expressed a preference for updated, trustworthy, web-based platforms to disseminate new research findings. Resources such as the Epilepsy & Pregnancy Medical Consortium website effectively disseminate accurate information. While these websites are crucial resources, they are not a comprehensive solution. Many patients may struggle to navigate the information or even be unaware of where to find it, highlighting the ongoing challenge of ensuring accessibility and awareness.
“Although there are considerable gaps in quality of care and access to care, I see this as an opportunity that personally energizes and motivates me to improve things at the local, regional and national levels,” said Kirkpatrick. “We need to ensure that expertise isn’t just concentrated in the hands of a few specialists with special training or interest, but that every neurologist, primary care provider and OB-GYN has a baseline knowledge of what the state of the science is and where to get accurate information.”
Fernanda Juarez Anaya is a PhD candidate in the Department of Neuroscience. Fernanda conducts research under the mentorship of Dr. Alberto Vazquez and Dr. Sarah Ross, focusing on the cellular and molecular mechanisms underlying neurovascular coupling. She is participating in the UPMC Science Writing Mentorship Program.
