Evaluation of the Knowledge of Women of Childbearing Age with Epilepsy about the Impact of Their Disease in Contraception, Pregnancy and Breastfeeding: A Multicenter Cross-Sectional Study

Authors

  • Pedro Lopes das Neves Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
  • Rita Ventura Serviço de Neurologia. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal.
  • André Sobral-Pinho Serviço de Neurologia. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal.
  • Elisa Silva Serviço de Neurologia. Hospital Garcia de Orta. Almada. Portugal.
  • Afonso Morgadinho Serviço de Neurologia. Hospital Garcia de Orta. Almada. Portugal.
  • Joana Vitor Serviço de Neurologia. Hospital Beatriz Ângelo. Loures. Portugal
  • Miguel Miranda Serviço de Neurologia. Hospital de Cascais Dr. José de Almeida. Cascais. Portugal.
  • Beatriz Madureira Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal.
  • Joana Moniz Dionísio Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal.
  • Rita Pinheiro Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal.
  • Sofia Delgado Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal.
  • Duarte Carapinha Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal.
  • André Rego Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal.
  • Francisca S´á Serviço de Neurologia. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal.
  • Maria Rita Pelejão Serviço de Neurologia. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal.
  • Francisco Antunes Serviço de Neurologia. Hospital Garcia de Orta. Almada. Portugal.
  • Inês Marques Serviço de Neurologia. Hospital Garcia de Orta. Almada. Portugal.
  • Vanessa Brito da Silva Serviço de Neurologia. Hospital Beatriz Ângelo. Loures. Portugal.
  • Sandra Castro Sousa Serviço de Neurologia. Hospital de Cascais Dr. José de Almeida. Cascais. Portugal.
  • João Peres Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal.
  • António Martins Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal.
  • Raquel Tojal Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal.

DOI:

https://doi.org/10.20344/amp.19156

Keywords:

Anticonvulsants, Breast Feeding, Contraception, Epilepsy/drug therapy, Health Knowledge, Attitudes, Practice, Pregnancy, Surveys and Questionnaires, Teratogenesis

Abstract

Introduction: The interaction of antiseizure medication with contraceptives, its potential teratogenicity and implications in pregnancy and breastfeeding are aspects to consider in the neurological care of women with epilepsy of childbearing age. To ensure the commitment in therapeutic decisions and the appropriate planning of maternity, it is essential that women are informed about the implications of their disease in these domains. The main aim of this study was to assess the knowledge of women of childbearing age with epilepsy concerning the impact of epilepsy in contraception, pregnancy and breastfeeding. As secondary aims we defined (1) the demographic, clinical and therapeutic characterization of this group of patients, (2) the identification of variables that correlated with the level of knowledge of women with epilepsy, and (3) the identification of preferential methods to acquire new knowledge about epilepsy.
Material and Methods: The study was observational, cross-sectional and multicentric, and was carried out in five hospitals of the Lisbon metropolitan area. After identifying all women of childbearing age with epilepsy followed in the epilepsy clinic of each center, we applied an electronic questionnaire based on a non-systematic review of the literature.
Results: One hundred and fourteen participants were validated, with a median age of 33 years. Half of the participants were on monotherapy, and the majority had no seizures in the last six months. We identified important gaps in the participants’ knowledge. Sections about complications and administration of antiseizure medication during pregnancy were the ones with the worst results. None of the clinical and demographic variables correlated with the final questionnaire score. Having had a previous pregnancy and the desire to breastfeed in a future pregnancy were positively correlated with the performance in breastfeeding section. Face-to-face discussion during medical outpatient visits was selected as the preferential method to learn about epilepsy, and the internet and social media were the least preferred ones.
Conclusion: The knowledge of women of childbearing age with epilepsy in the Lisbon metropolitan area concerning the impact of epilepsy in contraception, pregnancy and breastfeeding seems to have significant gaps. Medical teams should consider engaging in patient education particularly during outpatient clinics.

Downloads

Download data is not yet available.

References

Baeta É, Pimentel J, Luzeiro I, Guimarães P. Comissão Epilepsia no Feminino - Vigilância e tratamento da mulher com epilepsia: proposta de normas no âmbito da LPCE. Liga Portuguesa Contra a Epilepsia. 2011. [consultado 2020 mar 16]. Disponível em: https://epilepsia.pt/wp-content/uploads/2021/01/comisso-epilepsia-no-feminino_lpce_v1.pdf.

Li Y, Meador KJ. Epilepsy and pregnancy. Continuum. 2022;28:34-54. DOI: https://doi.org/10.1212/CON.0000000000001056

Coulam CB, Annegers JF. Do anticonvulsants reduce the efficacy of oral contraceptives? Epilepsia. 1979;20:519-25. DOI: https://doi.org/10.1111/j.1528-1157.1979.tb04834.x

Brodie MJ, Mintzer S, Pack AM, Gidal BE, Vecht CJ, Schmidt D. Enzyme induction with antiepileptic drugs: cause for concern? Epilepsia. 2013;54:11-27. DOI: https://doi.org/10.1111/j.1528-1167.2012.03671.x

O’Brien MD, Guillebaud J. Contraception for women taking antiepileptic drugs. J Fam Plann Reprod Health Care. 2010;36:239-42. DOI: https://doi.org/10.1783/147118910793048764

Harden CL, Meador KJ, Pennell PB, Allen Hauser W, Gronseth GS, French JA, et al. Management issues for women with epilepsy-focus on pregnancy (an evidence-based review): II. Teratogenesis and perinatal outcomes. Epilepsia. 2009;50:1237-46. DOI: https://doi.org/10.1111/j.1528-1167.2009.02129.x

Weston J, Bromley R, Jackson CF, Adab N, Clayton-Smith J, Greenhalgh J, et al. Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child. Cochrane Database Syst Rev. 2016;2016:CD010224. DOI: https://doi.org/10.1002/14651858.CD010224.pub2

Bromley R, Weston J, Adab N, Greenhalgh J, Sanniti A, Mckay AJ, et al. Treatment for epilepsy in pregnancy: neurodevelopmental outcomes in the child. Cochrane Database Syst Rev. 2014;2014:CD010236. DOI: https://doi.org/10.1002/14651858.CD010236.pub2

Harden CL, Hopp J, Ting TY, Pennell PB, French JA, Allen Hauser W, et al. Management issues for women with epilepsy - focus on pregnancy (an evidence-based review): I. Obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia. 2009;50:1229-36. DOI: https://doi.org/10.1111/j.1528-1167.2009.02128.x

Sveberg L, Svalheim S, Taubøll E. The impact of seizures on pregnancy and delivery. Seizure. 2015;28:29-32. DOI: https://doi.org/10.1016/j.seizure.2015.02.020

Harden CL, Pennell PB, Koppel BS, Hovinga CA, Gidal B, Meador KJ, et al. Management issues for women with epilepsy - Focus on pregnancy (an evidence-based review): III. Vitamin K, folic acid, blood levels, and breast-feeding: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia. 2009;50:1247-55. DOI: https://doi.org/10.1111/j.1528-1167.2009.02130.x

Pack AM, Davis AR, Kritzer J, Yoon A, Camus A. Antiepileptic drugs: are women aware of interactions with oral contraceptives and potential teratogenicity? Epilepsy Behav. 2009;14:640-4. DOI: https://doi.org/10.1016/j.yebeh.2009.01.024

Metcalfe A, Roberts JI, Abdulla F, Wiebe S, Hanson A, Federico P, et al. Patient knowledge about issues related to pregnancy in epilepsy: a crosssectional study. Epilepsy Behav. 2012;24:65-9. DOI: https://doi.org/10.1016/j.yebeh.2012.03.001

Dierking C, Porschen T, Walter U, Rösche J. Pregnancy-related knowledge of women with epilepsy — an internet-based survey in German-speaking countries. Epilepsy Behav. 2018;79:17-22. DOI: https://doi.org/10.1016/j.yebeh.2017.11.013

McGrath A, Sharpe L, Lah S, Parratt K. Pregnancy-related knowledge and information needs of women with epilepsy: a systematic review. Epilepsy Behav. 2014;31:246-55. DOI: https://doi.org/10.1016/j.yebeh.2013.09.044

Vazquez B, Gibson P, Kustra R. Epilepsy and women’s health issues: unmet needs-survey results from women with epilepsy. Epilepsy Behav. 2007;10:163-9. DOI: https://doi.org/10.1016/j.yebeh.2006.09.013

Kochen S. Pregnant women with epilepsy in a developing country. Open Neurol J. 2011;5:63-7. DOI: https://doi.org/10.2174/1874205X01105010063

Kampman MT, Johansen SV, Stenvold H, Acharya G. Management of women with epilepsy: are guidelines being followed? Results from case-note reviews and a patient questionnaire. Epilepsia. 2005;46:1286-92. DOI: https://doi.org/10.1111/j.1528-1167.2005.04205.x

Espinera AR, Gavvala J, Bellinski I, Kennedy J, Macken MP, Narechania A, et al. Counseling by epileptologists affects contraceptive choices of women with epilepsy. Epilepsy Behav. 2016;65:1-6. DOI: https://doi.org/10.1016/j.yebeh.2016.08.021

Abe K, Hamada H, Yamada T, Obata-Yasuoka M, Minakami H, Yoshikawa H. Impact of planning of pregnancy in women with epilepsy on seizure control during pregnancy and on maternal and neonatal outcomes. Seizure. 2014;23:112-6. DOI: https://doi.org/10.1016/j.seizure.2013.10.003

European Medicines Agency. PRAC recommends new measures to avoid valproate exposure in pregnancy. 2018. [consultado 2020 mar 15]. Disponível em: https://www.ema.europa.eu/en/documents/press-release/prac-recommends-new-measures-avoid-valproate-exposure-pregnancy_en.pdf.

Tomson T, Marson A, Boon P, Canevini MP, Covanis A, Gaily E, et al. Valproate in the treatment of epilepsy in girls and women of childbearing potential. Epilepsia. 2015;56:1006-19. DOI: https://doi.org/10.1111/epi.13021

Meador K, Reynolds MW, Crean S, Fahrbach K, Probst C. Pregnancy outcomes in women with epilepsy: a systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res. 2008;81:1-13. DOI: https://doi.org/10.1016/j.eplepsyres.2008.04.022

Hernández-Díaz S, McElrath TF, Pennell PB, Hauser WA, Yerby M, Holmes LB. Fetal growth and premature delivery in pregnant women on antiepileptic drugs. Ann Neurol. 2017;82:457-65. DOI: https://doi.org/10.1002/ana.25031

Birnbaum AK, Meador KJ, Karanam A, Brown C, May RC, Gerard EE, et al. Antiepileptic drug exposure in infants of breastfeeding mothers with epilepsy. JAMA Neurol. 2020;77:441-50. DOI: https://doi.org/10.1001/jamaneurol.2019.4443

Meador KJ, Baker GA, Browning N, Cohen MJ, Bromley RL, Clayton-Smith J, et al. Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA Pediatr. 2014;168:729-36. DOI: https://doi.org/10.1001/jamapediatrics.2014.118

Published

2023-03-28

How to Cite

1.
Lopes das Neves P, Ventura R, Sobral-Pinho A, Silva E, Morgadinho A, Vitor J, Miranda M, Madureira B, Moniz Dionísio J, Pinheiro R, Delgado S, Carapinha D, Rego A, S´á F, Pelejão MR, Antunes F, Marques I, Brito da Silva V, Castro Sousa S, Peres J, Martins A, Tojal R. Evaluation of the Knowledge of Women of Childbearing Age with Epilepsy about the Impact of Their Disease in Contraception, Pregnancy and Breastfeeding: A Multicenter Cross-Sectional Study. Acta Med Port [Internet]. 2023 Mar. 28 [cited 2024 Apr. 20];36(6):383-9. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/19156

Issue

Section

Original