Sexual and reproductive health concerns of women with epilepsy beginning in adolescence and young adulthood

Laura Kirkpatrick; Elizabeth Harrison; Sonya Borrero; Elizabeth Miller; Yoshimi Sogawa; Olivia M Stransky; Mehret Birru Talabi; Alexandra Urban; Traci M Kazmerski

doi:10.1016/j.yebeh.2021.108439

Sexual and reproductive health concerns of women with epilepsy beginning in adolescence and young adulthood

Epilepsy Behav. 2021 Dec:125:108439. doi: 10.1016/j.yebeh.2021.108439. Epub 2021 Nov 25.

Authors

Laura Kirkpatrick¹, Elizabeth Harrison², Sonya Borrero³, Elizabeth Miller⁴, Yoshimi Sogawa⁵, Olivia M Stransky⁶, Mehret Birru Talabi⁷, Alexandra Urban⁸, Traci M Kazmerski⁹

Affiliations

¹ UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224, United States. Electronic address: laura.kirkpatrick2@chp.edu.
² UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224, United States. Electronic address: harrisonei2@upmc.edu.
³ Center for Women's Health Research and Innovation, University of Pittsburgh, 230 McKee Place, Pittsburgh, PA 15213, United States; Department of Medicine, University of Pittsburgh, 1218 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, United States. Electronic address: borrsp@upmc.edu.
⁴ UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224, United States; Center for Women's Health Research and Innovation, University of Pittsburgh, 230 McKee Place, Pittsburgh, PA 15213, United States. Electronic address: Elizabeth.miller@chp.edu.
⁵ UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224, United States. Electronic address: yoshimi.sogawa@chp.edu.
⁶ Center for Women's Health Research and Innovation, University of Pittsburgh, 230 McKee Place, Pittsburgh, PA 15213, United States. Electronic address: ols25@pitt.edu.
⁷ Center for Women's Health Research and Innovation, University of Pittsburgh, 230 McKee Place, Pittsburgh, PA 15213, United States; Department of Medicine, University of Pittsburgh, 1218 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, United States. Electronic address: birrums@upmc.edu.
⁸ Department of Neurology, University of Pittsburgh, 811 Kaufmann Medical Building, 3461 Fifth Avenue, Pittsburgh, PA 15213, United States. Electronic address: urbana1@upmc.edu.
⁹ UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224, United States; Center for Women's Health Research and Innovation, University of Pittsburgh, 230 McKee Place, Pittsburgh, PA 15213, United States. Electronic address: traci.kazmerski@chp.edu.

PMID: 34839241
DOI: 10.1016/j.yebeh.2021.108439

Abstract

Background: Women with epilepsy (WWE) have potentially unique concerns regarding their sexual and reproductive health (SRH). Prior studies of WWE have focused narrowly on pregnancy and preconception experiences, and have not addressed concerns of nulliparous adolescent and young adult women not actively seeking pregnancy.

Methods: We conducted individual semi-structured interviews with WWE 18-45 years of age. We sampled to maximize diversity of age and parity, and intentionally included many adolescent and young adult nulliparous women not actively planning pregnancy. Interviews broadly addressed participants' SRH concerns and experiences. Interviews were audio-recorded and transcribed. Two coders performed qualitative analysis using thematic analysis with deductive and inductive approaches.

Results: Twenty WWE (median age 23 years, range 18-43 years) completed interviews. Twelve were nulliparous, six had children, one had a history of miscarriage only, and two were currently pregnant. WWE's narratives revealed significant concerns about family planning and reproductive health in the context of epilepsy, including: 1) seizures endangering pregnancies and children 2) teratogenic effects of antiseizure medication, 3) heritability of epilepsy, 4) antiseizure medication and epilepsy impacting fertility, and 5) interactions between antiseizure medication and contraception.

Conclusion: WWE, including nulliparous adolescent and young adult women who are not actively planning pregnancy, have significant concerns about how their epilepsy interacts with SRH. SRH counseling for WWE should begin during adolescence and be incorporated into the transition process from pediatric to adult healthcare. Insights from WWE may aid in the creation of relevant patient-facing educational resources as well as provider-facing training and tools to meaningfully support the reproductive decision-making of WWE throughout their childbearing years.

Keywords: Adolescence; Reproductive health; Sexual health; Women with epilepsy.

MeSH terms

Adolescent
Adult
Child
Contraception
Epilepsy*
Female
Humans
Pregnancy
Reproduction
Reproductive Health
Sexual Health*
Young Adult