BALTIMORE Neurologists should repeatedly remind young female patients with epilepsy, particularly those who are black, to take folic acid, new research suggests.
Deepti Zutshi, MD
A new pregnancy-outcomes study showed that black women with epilepsy are about half as likely to take folic acid as their counterparts of other racial backgrounds and are significantly more likely to have an unplanned pregnancy and later complications.
Clinicians should discuss the importance of taking folic acid with their female patients with epilepsy not just once but at every visit, said study investigator Deepti Zutshi, MD, assistant professor of neurology, Comprehensive Epilepsy Center, Wayne State University, Detroit, Michigan.
"It's important to really enforce this message and start when patients are young; start at puberty," Zutshi told Medscape Medical News.
The findings were presented here at the American Epilepsy Society (AES) 73rd Annual Meeting 2019.
The study included 104 pregnancies in patients at the High Risk Pregnancy and Epilepsy Clinic in Detroit. Of these pregnancies, 79.8% were among black women.
"I had a unique opportunity to add to what we know already about pregnancy outcomes in this population," Zutshi said.
Black participants were comparable to the other participants in terms with a mean age of 26 years, duration of epilepsy of just over 10 years, and seizure type, which was mostly focal and generalized.
Nevertheless, black participants were significantly more likely to have an unplanned pregnancy (83% vs 63%, respectively; P = .02).
"The next step is to figure out the reason for this discrepancy," said Zutshi.
This includes looking at cultural differences, stigma, and whether they receive or have access to birth control counseling and counseling on the potential risks of birth defects associated with antiepileptic drugs, she added.
The study also showed that black women were less likely to have taken folic acid pre-conception (22% vs 55%), possibly because they weren't counseled to do so, said Zutshi.
"The problem could be lack of access to prenatal care, lack of access to an OB-GYN, maybe lack of access to a neurologist who needs to prescribe folic acid to women who are on antiepileptic drugs," Zutshi said.
However, even if women are prescribed folic acid, they may not take it, she added.
"Anecdotally, that's because they don't know why they should be taking it. When you prescribe it, you have to explain what it is and what it does" to help prevent complications such as neural tube defects, Zutshi noted.
Most doctors already counsel their female patients with epilepsy to take folic acid, but patients need reminding as they may be taking antiseizure medicines and dealing with numerous other issues, Zutshi said. "It's all about repetition," she added.
Barriers to prenatal care for black women, especially those with epilepsy, include younger age at pregnancy, no means of transportation, not realizing they are pregnant until later gestation, and lack of education.
About 48% of black participants, vs 41% of the other women in the study, had at least one seizure during pregnancy.
Pregnancy complications, including miscarriages and premature deliveries, were skewed toward black women and again, likely reflects lack of prenatal care, Zutshi said.
In the nonblack participant group, there was one case of threatened miscarriage vs five cases in the group of black women. The latter group also had six cases of premature delivery and three cases each of eclampsia/preeclampsia and congenital malformation vs zero cases in the group of nonblack participants.
Black women are not well represented in national pregnancy registries; and most of these registries recruit women in the first trimester before they have their 18- to 22-week ultrasound, Zutshi noted.
"I'm getting patients way into their second and third trimester. Why weren't they referred to me beforehand?" said Zutshi.
Future studies should compare pregnancy outcomes in black women with, and without, epilepsy, Zutshi said.
"That research needs to control for whether [black patients] receive prenatal care. I think that's probably one of the biggest confounding factors you have to consider when you do that comparison," she added.
Commenting on the study for Medscape Medical News, Anna Serafini, MD, director of the Epilepsy Monitoring Unit and assistant professor in the Department of Neurology and Rehabilitation, University of Illinois, Chicago, said the new information is useful.
"It shows that we need to target the African American population even more, and we need to remember that the majority of pregnancies in this population are unplanned," said Serafini, who was not involved in the research.
She said she prescribes 1 mg of folate per day to all her patients with epilepsy of childbearing age, even if they insist they are not planning to become pregnant. She raises the dose to 4 mg once a woman does become pregnant. Many multivitamins geared to women contain folate.
However, she acknowledged that many patients don't follow her advice.
A limitation cited by Serafini was that there were relatively few nonblack women in the study. "It would be interesting to increase that number to have a better comparison," she said.
She also agreed that data in national pregnancy registries come from very select patient populations.
"We need to start to include more populations such as African Americans because the data might be different," said Serafini.
American Epilepsy Society (AES) 73rd Annual Meeting 2019: Abstract 3.24. Presented December 9, 2019.
For more Medscape Neurology news, join us on Facebook and Twitter.
Link:
Folate in Young Women With Epilepsy: Start Early, Remind Often - Medscape
- Serotonin Blocker May Build New Bone in Osteoporotic Mice by Decreasing GI Serotonin Levels [Last Updated On: August 17th, 2024] [Originally Added On: April 5th, 2010]
- The two current heavyweight world boxing champions both have PhDs, believe or not [Last Updated On: August 17th, 2024] [Originally Added On: April 6th, 2010]
- Video: Why submit your research to the BMJ? [Last Updated On: August 17th, 2024] [Originally Added On: April 6th, 2010]
- How does clinical evidence work? [Last Updated On: August 17th, 2024] [Originally Added On: April 7th, 2010]
- How To: Getting Smart During Your Daily Commute [Last Updated On: August 17th, 2024] [Originally Added On: April 7th, 2010]
- Scaring physicians aways from using social media [Last Updated On: August 17th, 2024] [Originally Added On: April 12th, 2010]
- Eradication of nasal colonization with S. aureus associated with a decrease in postoperative surgical-site infections [Last Updated On: August 17th, 2024] [Originally Added On: April 12th, 2010]
- Martina Navratilova Fighting Breast Cancer - ABC Video [Last Updated On: August 17th, 2024] [Originally Added On: April 12th, 2010]
- Are doctors ready for virtual visits? Telemedicine may not be accurate enough. [Last Updated On: August 17th, 2024] [Originally Added On: April 12th, 2010]
- Jamie Oliver at TED: Teach every child about food [Last Updated On: August 17th, 2024] [Originally Added On: April 12th, 2010]
- "Europeans Work to Live and Americans Live to Work" But Who is Happier? [Last Updated On: August 17th, 2024] [Originally Added On: April 12th, 2010]
- 29 Debates About the "Right Way" to Blog [Last Updated On: August 17th, 2024] [Originally Added On: April 12th, 2010]
- Johns Hopkins Medicine podcast now has a blog [Last Updated On: August 17th, 2024] [Originally Added On: April 13th, 2010]
- Health experts' tips for safe international travel [Last Updated On: August 17th, 2024] [Originally Added On: April 13th, 2010]
- How to use Google Docs Drawings for medical mind maps [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
- Australian grandmother beats off attacking shark - BBC [Last Updated On: August 17th, 2024] [Originally Added On: April 14th, 2010]
- Nonsurgical Weight Loss with a Liquid Meal Program - Mayo Clinic Video [Last Updated On: August 17th, 2024] [Originally Added On: April 15th, 2010]
- Vitamin D deficiency occurs frequently in COPD and correlates with severity [Last Updated On: August 17th, 2024] [Originally Added On: April 16th, 2010]
- Taking charge of your toddler's vaccination record is the best way to ensure they don't miss any shots [Last Updated On: August 17th, 2024] [Originally Added On: April 16th, 2010]
- The College of American Pathologists unveils a new patient website MyBiopsy.org [Last Updated On: August 17th, 2024] [Originally Added On: April 17th, 2010]
- Better Sleep, Better Learning? Obstructive sleep apnea can reduce a child’s IQ by 10 points [Last Updated On: August 17th, 2024] [Originally Added On: April 18th, 2010]
- Mobile Medicine via iPod/iPhone/iPad Apps [Last Updated On: August 17th, 2024] [Originally Added On: April 19th, 2010]
- AskaPatient.com - Medication Ratings and Health Care Opinions [Last Updated On: August 17th, 2024] [Originally Added On: April 21st, 2010]
- Standardized patient: Over the course of three days, I had 23 head-to-toe physicals from 23 medical students [Last Updated On: August 17th, 2024] [Originally Added On: April 22nd, 2010]
- 500 repetitions of 4 cardiac murmurs improved auscultatory proficiency of medical students [Last Updated On: August 17th, 2024] [Originally Added On: April 23rd, 2010]
- Rock legend Ronnie James Dio is fighting stomach cancer [Last Updated On: August 17th, 2024] [Originally Added On: April 23rd, 2010]
- Hockey-puck-on-a-rod test checks for concussion after head trauma [Last Updated On: August 17th, 2024] [Originally Added On: April 24th, 2010]
- Occupation may be a key factor in lung cancer [Last Updated On: August 17th, 2024] [Originally Added On: April 25th, 2010]
- FDA: High-dose simvastatin increases risk of muscle injury - caution with lower doses plus Amiodarone, Verapamil, Diltiazem [Last Updated On: August 17th, 2024] [Originally Added On: April 26th, 2010]
- Fish out of pills - Pharmaceuticals in drinking water [Last Updated On: August 17th, 2024] [Originally Added On: April 27th, 2010]
- 3-gram reduction in daily salt intake would decrease coronary heart disease, stroke, and death [Last Updated On: August 17th, 2024] [Originally Added On: April 27th, 2010]
- The men behind famous eponymous diseases [Last Updated On: August 17th, 2024] [Originally Added On: April 28th, 2010]
- Medical school letters of recommendation have formally been replaced by tweets [Last Updated On: August 17th, 2024] [Originally Added On: April 29th, 2010]
- "The doctor in literature: Private life" by Solomon Posen at Google Books [Last Updated On: August 17th, 2024] [Originally Added On: April 29th, 2010]
- High deductible health insurance can be bad for your health [Last Updated On: August 17th, 2024] [Originally Added On: April 30th, 2010]
- Should Doctors ‘Prescribe’ a Drink a Day? No. [Last Updated On: August 17th, 2024] [Originally Added On: May 1st, 2010]
- Turning medical residents away from copy-and-paste culture facilitated by EMR [Last Updated On: August 17th, 2024] [Originally Added On: May 2nd, 2010]
- Some nurses paid more than family doctors - CNN [Last Updated On: August 17th, 2024] [Originally Added On: May 2nd, 2010]
- Tiotropium for COPD: A good foundation therapy for most patients [Last Updated On: August 17th, 2024] [Originally Added On: May 2nd, 2010]
- Approach to evaluation and management of syncope in adults - BMJ Review [Last Updated On: August 17th, 2024] [Originally Added On: May 4th, 2010]
- U.S. Hospital Social Media List Includes More Than 600 Hospitals [Last Updated On: August 17th, 2024] [Originally Added On: May 4th, 2010]
- Can You Tell Your Life Story In 6 Words? [Last Updated On: August 17th, 2024] [Originally Added On: May 5th, 2010]
- How do you keep up with health news? [Last Updated On: August 17th, 2024] [Originally Added On: May 6th, 2010]
- Diet: For every 1% increase in omega-3 intake, HDL levels rose by 2.5 mg/dL [Last Updated On: August 17th, 2024] [Originally Added On: May 6th, 2010]
- Benefits and Dangers as Doctors Start to Use Social Media [Last Updated On: August 17th, 2024] [Originally Added On: May 7th, 2010]
- How to Subscribe to "What's New" Specialty Page of UpToDate? No Feed, No Problem for Google Reader [Last Updated On: August 17th, 2024] [Originally Added On: May 8th, 2010]
- High-risk profession: Suicide rate of U.S. doctors is one per day [Last Updated On: August 17th, 2024] [Originally Added On: May 8th, 2010]
- Video: A life cycle in 90 seconds [Last Updated On: August 17th, 2024] [Originally Added On: May 9th, 2010]
- Eating chocolate with high flavanol levels can protect the skin from UV light [Last Updated On: August 17th, 2024] [Originally Added On: May 10th, 2010]
- Barbara Walters, US TV Anchor, to Undergo Heart Surgery to Replace a "Faulty Valve" - Sounds Like Aortic Stenosis [Last Updated On: August 17th, 2024] [Originally Added On: May 11th, 2010]
- Can a Midday Nap Make You Smarter? Adults Who Nap for 90-minutes at 2 PM Learn and Perform Better at Tests [Last Updated On: August 17th, 2024] [Originally Added On: May 11th, 2010]
- 17% of food-related asphyxiations were caused by hot dogs - "the perfect plug for a child's airway" [Last Updated On: August 17th, 2024] [Originally Added On: May 12th, 2010]
- Bloggers, too much sitting can offset the benefits of regular exercise [Last Updated On: August 17th, 2024] [Originally Added On: May 13th, 2010]
- Farm-raised salmon has 16 times the polychlorinated biphenyls (PCBs) as wild-caught salmon [Last Updated On: August 17th, 2024] [Originally Added On: May 13th, 2010]
- Back and forth: Study fails to show link previously found between virus and chronic fatigue syndrome [Last Updated On: August 17th, 2024] [Originally Added On: May 14th, 2010]
- Warfarin Sensitivity Genotype Test - Mayo Clinic Video [Last Updated On: August 17th, 2024] [Originally Added On: May 14th, 2010]
- Childhood diabetes associated with increasing birth weight - 7% increase in risk for every 1000 g in weight [Last Updated On: August 17th, 2024] [Originally Added On: May 15th, 2010]
- The Barefoot Professor says barefoot running could minimize injuries [Last Updated On: August 17th, 2024] [Originally Added On: May 15th, 2010]
- Açaí, a Global "Super Fruit", Is Regular Dinner Meal in Brazil [Last Updated On: August 17th, 2024] [Originally Added On: May 16th, 2010]
- A NYTimes skeptic doubts that decreasing salt intake would have any benefits (it may even hurt) [Last Updated On: August 17th, 2024] [Originally Added On: May 17th, 2010]
- TED video: CIO of Cleveland Clinic talks about electronic medical records (EMR) [Last Updated On: August 17th, 2024] [Originally Added On: May 18th, 2010]
- Hospitalist evolution? "Extensivist" = hospitalist who prevents readmissions by seeing patients after discharge [Last Updated On: August 17th, 2024] [Originally Added On: May 18th, 2010]
- Video: Cleveland Clinic Model of Medicine [Last Updated On: August 17th, 2024] [Originally Added On: May 19th, 2010]
- What is the oldest medical blog? [Last Updated On: August 17th, 2024] [Originally Added On: May 19th, 2010]
- 7.2% Decrease in Work Hours of U.S. Physicians Between 1996 and 2008 [Last Updated On: August 17th, 2024] [Originally Added On: May 20th, 2010]
- Osteoporosis Drug Lasofoxifene May "Fight" Several Diseases But Increases Risk of Blood Clots [Last Updated On: August 17th, 2024] [Originally Added On: May 21st, 2010]
- Sign of the times [Last Updated On: August 17th, 2024] [Originally Added On: May 21st, 2010]
- Antibiotic use for respiratory infections could be reduced by 40% by procalcitonin (PCT) test [Last Updated On: August 17th, 2024] [Originally Added On: May 22nd, 2010]
- "Blogging fame does not pay the bills" [Last Updated On: August 17th, 2024] [Originally Added On: May 22nd, 2010]
- Health benefits of chocolate [Last Updated On: August 17th, 2024] [Originally Added On: May 23rd, 2010]
- Metabolic pathway plays a role in susceptibility to stuttering [Last Updated On: August 17th, 2024] [Originally Added On: May 23rd, 2010]
- Physically fit students score higher on tests than their less fit peers [Last Updated On: August 17th, 2024] [Originally Added On: May 24th, 2010]
- Room-temperature plasma gases may replace hand disinfectants [Last Updated On: August 17th, 2024] [Originally Added On: May 25th, 2010]
- New Treatment Effective in Killing Head Lice - benzyl alcohol lotion 5% (Ulesfia) [Last Updated On: August 17th, 2024] [Originally Added On: May 25th, 2010]
- Doctors use Facebook pages to connect with patients [Last Updated On: August 17th, 2024] [Originally Added On: May 26th, 2010]
- TED Talks: A new strategy in the war on cancer [Last Updated On: August 17th, 2024] [Originally Added On: May 26th, 2010]
- Oral Tolvaptan (Samsca) Is Safe and Effective in Chronic Hyponatremia [Last Updated On: August 17th, 2024] [Originally Added On: May 26th, 2010]
- Medical blog content and relationship with blogger credentials and blog host [Last Updated On: August 17th, 2024] [Originally Added On: May 27th, 2010]
- Doctors should blog with their real name - agree or disagree? [Last Updated On: August 17th, 2024] [Originally Added On: May 29th, 2010]
- "I'm a Medicare doctor. Here's what I make" [Last Updated On: August 17th, 2024] [Originally Added On: May 29th, 2010]