Contraceptive Practices of Women with Epilepsy: Findings of the Epilepsy Birth Control Registry (S6.003)

OBJECTIVE: To report the contraceptive practices of women with epilepsy (WWE) in the community and identify factors which predict the use of highly effective contraception (HEC). BACKGROUND: Although contraception presents special challenges for WWE because of the potential effects of neuroactive steroids on seizures and some interactions between hormones and antiepileptic drugs, there have been no large scale investigations of contraceptive practices in WWE in the community. DESIGN/METHODS: The Epilepsy Birth Control Registry, a web-based survey that gathers demographic, epilepsy, antiepileptic drug, reproductive and contraceptive data from WWE in the community, provided cross sectional data from 1107 subjects, ages 18-47 years. We used binary logistic regression to determine predictors of HEC use among WWE at risk (potentially fertile and sexually active) but not currently seeking pregnancy. HEC included systemic hormonal methods, IUD, tubal ligation and vasectomy. Predictor factors were age, race/ethnicity, education, household income and insurance. RESULTS: WWE at risk (N = 767) used the following contraceptive methods (combinations are listed by the more effective method): none-16 (2.1[percnt]), withdrawal-35 (4.6[percnt]), barrier-180 (23.5[percnt]), systemic hormonal-357 (46.6[percnt]), IUD-130 (16.9[percnt]), tubal ligation-31 (4.0[percnt]), vasectomy-18 (2.3[percnt]). 536 (69.8[percnt]) used HEC methods. Significant predictors were insurance (OR for HEC use with insurance [72.8[percnt]] versus no insurance [52.8[percnt]] was 2.140 [1.311-3.493]; p = .002); age (OR for each year relative to the youngest was 1.043 [1.015-1.071]; p = 0.002) and race/ethnicity (OR for minorities [54.2[percnt]] versus whites [72.2[percnt]] was 0.483 [0.257-0.909]; p = 0.024). HEC use was progressively greater with age: 38-47 year old cohort: 78.8[percnt], 28-37 cohort: 73.8[percnt], 18-27 cohort: 67.4[percnt]. CONCLUSIONS: The majority of WWE in the survey use what is generally considered to be HEC. Efficacy in WWE, however, remains to be demonstrated. The findings identify lower use of HEC among younger, minority and uninsured WWE. Study Supported by: Epilepsy Foundation and Lundbeck Disclosure: Dr. Herzog has received research support from Lundbeck Research USA, Inc. Dr. Mandle has nothing to disclose. Dr. Davis has nothing to disclose. Dr. Hauser has received personal compensation for activities with Pfizer Inc., Ovation Pharmaceuticals, and Valeant Pharmaceuticals as a consultant.