Access to Expert Pregnancy Care for Women with Epilepsy

1439 

Traditional Abstracts 

Chloe Hill  
N/A
Ann Arbor, MI

Barbara Decker  
Baptist Health
Jacksonville, FL

Danielle Becker, MD, MS  
The Ohio State University
Columbus, OH

Temenuzhka Mihaylova, MD, PhD  
University of Michigan
Ann Arbor, MI

Giselle Kolenic, MA  
University of Michigan
Ann Arbor, MI

Alex Peahl, MD, MSc  
University of Michigan
Ann Arbor, MI

Chun Chieh Lin  
The Ohio State University
Columbus, OH

Chloe Hill  
N/A
Ann Arbor, MI

Women with epilepsy (WWE) have higher rates of perinatal morbidity and mortality compared to the general population. Additionally, infants born to WWE have elevated risks of congenital malformations, adverse perinatal outcomes, and poor neurocognitive development. Practice guidelines advise perinatal risk reduction strategies for WWE, such as optimizing antiseizure medication (ASM). However, WWE may not be able to access timely, expert care.

We found 45% of WWE did not see a neurologist in the year prior to delivery. Notably, this result likely underestimates the care gap, as perinatal management of WWE involves specialized expertise. It appears that WWE who do see neurologists may have epilepsy that is harder to treat. Further work should evaluate the association of neurologist care with risk reduction strategies and clinical outcomes.

Using a nationally-representative commercial administrative claims dataset (Marketscan), we identified women with 1) a delivery date during 2016-2021, 2) ≥1 epilepsy claim one year prior to pregnancy, and 3) ≥28 days of ASM supply in the two years prior to delivery. Our primary outcome was neurologist care, including clinic visits, ER visits, hospitalizations, or procedure/tests during pregnancy (approximated as the year prior to delivery). We characterized other specialists' care and ASM regimens.

We identified 2385 WWE with a delivery date within the study period. In the year prior to delivery, 55% (1322) saw a neurologist. In total, 79% (1874) saw an obstetrician, 5% a midwife, 68% a PCP, 26% an NP/PA, and 38% an emergency medicine physician. Most WWE (59%) were on one ASM in the year prior to delivery, 17% on two, and 5% on three or more ASMs; 19% had no ASM claims in the year prior to delivery. In total, 62% of WWE were on a recommended ASM (i.e., levetiracetam, lamotrigine, oxcarbazepine). Regarding less favorable ASMs, 3% were taking valproic acid at some point in the year prior to delivery, 10% topiramate, and 0.3% phenobarbital. WWE who saw a neurologist were more likely to be on a recommended ASM (74% vs. 48%, p<0.01) and less likely to not be taking an ASM (8% vs. 33%, p<0.01). WWE who saw a neurologist were less likely to stop their ASM in the year before delivery (8% vs. 33%, p<0.01). Use of a less favorable ASM was more common among WWE seen by a neurologist compared to WWE not seen (15% vs. 10%, p<0.01) as was polytherapy (28% vs. 14%, p<0.01).

Epilepsy

Health Services and Health Equity Research