Reproductive Counseling Practices for Women with Epilepsy: Folic Acid Supplementation, Contraception, and Pregnancy Risk Counseling

Women of childbearing potential with epilepsy are at increased risk of adverse fetal outcomes due to both the condition and the teratogenic effects of antiseizure medications (ASMs). Reproductive counseling and folic acid supplementation are critical for reducing risks of unplanned pregnancy and birth defects. The American Academy of Neurology (AAN) has established quality measures to guide these practices; however, adherence remains unclear across clinical settings. This retrospective, single-center study evaluated differences in pregnancy counseling, folic acid supplementation, and contraception use among patients aged 18–44 treated at a specialty Epilepsy Clinic versus a General Neurology Clinic at UNC Health (July 2022–June 2023). Inclusion criteria included individuals assigned female at birth, capable of pregnancy, and prescribed at least one ASM. A total of 536 patients were included (Epilepsy n=434; General n=102). Pregnancy counseling was documented in 56% of patients in the Epilepsy Clinic compared to 22% in the General Clinic (χ²=40, p<0.05). Patients in the Epilepsy Clinic had 4.7 times higher odds of receiving counseling (OR=4.71; 95% CI 2.83–7.83). These findings demonstrate significant disparities in reproductive counseling practices and highlight the need for standardized approaches to improve guideline implementation across neurology settings.