ANTIEPILEPTIC MEDICATION AND ORAL-CONTRACEPTIVE INTERACTIONS - A NATIONAL SURVEY OF NEUROLOGISTS AND OBSTETRICIANS

Hepatic enzyme-inducing. antiepileptic drugs (AEDs) lower oral contrac eptive (OC) sex hormone levels approximately 40% and increase the risk of unplanned pregnancies in women with epilepsy, AEDs also increase t he risk of birth defects in offspring of women with epilepsy. We perfo rmed a national survey to determine obstetricians' and neurologists' k nowledge of OC and AED interactions and the risk of birth defects for women with epilepsy taking AEDs. We received responses to a mailed que stionnaire from 160 of 1,000 neurologists (16%) and 147 of 1,000 obste tricians (15%) from 41 states. Practice demographics and ages of respo nder were typical for U.S. neurologists and obstetricians. Ninety-one percent of neurologists and 75% of obstetricians said they treat women with epilepsy of child-bearing age, Only 4% of the neurologists and n one of the obstetricians, however, knew the effects of the six most co mmon AEDs on OCs, even though 27% of neurologists and 21% of obstetric ians reported OC failures in their patients taking AEDs. Although incr easing OC doses can compensate for insufficient OC sex hormone levels due to AEDs, most physicians do not increase the doses. Even though th e risk of birth defects for the offspring of women with epilepsy is 4 to 6%, up from the background level of 2%, 44% of neurologists thought the risk was lower (0 to 3%), and some of the respondents guessed tha t it was as high as 50%. Many neurologists and obstetricians do not ha ve accurate informatian to counsel women with epilepsy properly about their contraceptive and pregnancy choices.