Improved Counseling Needed for Safe, Effective Contraception in Women With Epilepsy

Despite the elevated risk of having an offspring with congenital malformations, a large proportion of women with epilepsy do not use highly effective contraception.

Despite the elevated risk of having offspring with congenital malformations, a large proportion of women with epilepsy do not use highly effective contraception, according to a study published in Neurology.

In this cross-sectional study, investigators analyzed data from the Epilepsy Birth Control Registry online survey data collected in 2017 by women with epilepsy aged between 18 and 47 years (n=311). Data included demographics, epilepsy classification, antiepileptic drug use, reproductive status, and contraceptive habits.

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Participants were asked to characterize their seizures as generalized convulsive, complex partial, and simple partial and provide the names and daily dosages of antiepileptic drugs. Investigators grouped antiepileptic drugs into 6 categories: none, enzyme-inducing, glucuronidated, non-enzyme-inducing, enzyme-inhibiting, and mixed. If there was a combination of categories that affected enzymes and a non-enzyme-inducing antiepileptic drug, the combination was listed by the antiepileptic drug category that affected enzymes. If there were more than 2 categories that affected enzymes, they were listed as mixed. Current contraception use was categorized as none, withdrawal, barrier method, hormonal, intrauterine device, tubal ligation, or partner with vasectomy.

Women with epilepsy considered to be at risk for unintended pregnancy (n=186) were the primary focus of analysis. Results show in the year prior the survey, 31.2% of women with epilepsy (n=58) reported having a generalized convulsive seizure, and 68.8% (n=128) reported having a partial seizure. Of these women, 70.4% (n=131) used a highly effective contraceptive category, including hormonal (37.6% [n=70]), intrauterine device (30.6% [n=57]), tubal ligation (1.1% [n=2]), or partner vasectomy (1.1% [n=2]).

Among women with epilepsy at risk for pregnancy 29.6% used no highly effective contraceptive (n=55), including no birth control (2.2% [n=4]), withdrawal method (4.3% [n=8]), or barrier only (23.1% [n=43]).

In sum, 36.6% of women with epilepsy (n=68; 95% CI, 30%-43.7%) were not using highly effective contraception. No significant difference between the use (or lack of use) of highly effective contraceptives was found.

Of note, only 50% of women with epilepsy at risk for unintended pregnancy (regardless of contraception use) were taking a prenatal folic acid supplement as part of their treatment regimen, despite practice guidelines emphasizing its importance in maximizing maternal and fetal outcomes.

The investigators concluded that “[t]here is a need for more readily available information and counseling on safe and effective contraception and [folic acid] use for this community.”

This study was supported by Lundbeck. Please refer to reference for a complete list of authors’ disclosures.


Herzog AG, Mandle HB, MacEachern DB. Prevalence of highly effective contraception use by women with epilepsy [published online May 17, 2019]. Neurology. doi: 10.1212/WNL.0000000000007581