Abortion Ban May Mean Denial of Effective Drugs for Women With MS, Migraine and Epilepsy

Summary: New abortion bans and restrictions could result in life-threatening consequences for women of childbearing age with epilepsy, multiple sclerosis, and migraine due to restrictions placed on their ability to access life-saving medications. Patients in states with strict abortion restrictions are reporting they cannot access teratogenic drugs to treat their conditions, including methotrexate, as the medications can induce abortion.

Source: UCSF

The dissolution of Roe v. Wade is expected to lead to abortion bans or severe restrictions in as many as 28 states. These new restrictions may have life-changing and even life-threatening consequences in these states for women of childbearing age with conditions like migraine, multiple sclerosis (MS) and epilepsy.

In their perspective article, publishing in JAMA Neurology on July 13, 2022, neurologists from UC San Francisco focus on the hazards abortion restrictions pose to women of reproductive age, who are disproportionately affected by these conditions, and the medications that treat them.

These include drugs that have not been shown to be safe during pregnancy, and so-called teratogenic drugs that are linked to birth defects in the developing embryo and fetus. 

“In a climate of increased limitations on reproductive rights, whereby pregnancies cannot be reliably timed or prevented, neurologists might possibly restrict use of the effective medications that are standard care for other patient groups because of potential concerns about causing fetal harm,” writes corresponding author Sara LaHue, MD, of the UCSF Department of Neurology and the Weill Institute for Neurosciences.

“This could increase risk of morbidity, mortality and irreversible disability accumulation for women with neurologic diseases.”

Women with some neurological conditions, including epilepsy, face an increased likelihood of unplanned pregnancy, since certain treatments may reduce the efficacy of hormonal contraceptives. For those patients with status epilepticus, a type of seizure that may lead to brain damage or death, valproic acid, a teratogen, may be required to stop the seizures.

Other teratogenic drugs include methotrexate and mycophenolate mofetil, which treat autoimmune disorders like MS and myasthenia gravis. “Even if prescribed for a neurological condition, there are reports from patients across the country stating they are now unable to access methotrexate because it can also be used to induce abortion,” said LaHue. 

Some Medications Ruled Out for All Women of Reproductive Age

“Teratogenic drugs are only prescribed when it is possible for women to plan pregnancies and prevent fetal exposure. However, controlling the timing of teratogenic medication use may not be feasible in the short term,” said LaHue, referring to status epilepticus, encephalitis and vasculitis. 

This shows a woman's head and a drawing of a brain
These include drugs that have not been shown to be safe during pregnancy, and so-called teratogenic drugs that are linked to birth defects in the developing embryo and fetus. Image is in the public domain

Monoclonal antibody treatments are prescribed for patients with migraine, MS and myasthenia gravis, but may not be safe during pregnancy. Some neurologists may rule out these medications for all women of reproductive age, according to the authors. 

“In many settings, women with MS are treated with less effective therapies, because these medications are perceived to be safer in pregnancy,” said co-author Riley Bove, MD, MSc, of the UCSF Department of Neurology and the Weill Institute for Neurosciences.

“Often, neurologists are not familiar with how to time or optimize certain medications, or of their updated safety profile. The reversal of Roe v. Wade may reinforce decisions to stick with the less effective therapies, which may result in irreversible disability for some women with MS.”

Availability of reproductive health is “integral to equitable delivery of neurologic care,” the authors conclude. Equity in care depends on the unrestricted liberty to make personal decisions affecting bodily autonomy, including “optimization of fertility windows, personal determination of pregnancy timing to limit disease progression or exacerbation, and pregnancy termination if necessary for the health of the mother, the fetus or both.” 

About this neurology and neuropharmacology research news

Author: Suzanne Leigh
Source: UCSF
Contact: Suzanne Leigh – UCSF
Image: The image is in the public domain

Original Research: Closed access.
Reproductive Rights in Neurology—The Supreme Court’s Impact on All of Us” by Sara LaHue et al. JAMA Neurology


Reproductive Rights in Neurology—The Supreme Court’s Impact on All of Us

The overturning of Roe v Wade through the US Supreme Court’s official ruling in Dobbs v Jackson Women’s Health Organization is already having an undeniable ripple effect on health care delivery across the nation.

How this may change clinical practice for both adult and child neurologists and management of neurologic diseases appears initially less relevant.

Neurologists rarely prescribe contraception or menopausal hormone therapy and do not participate in fertility treatment procedures or terminations of pregnancy.

Except for contraception, these topics are seldom included in training and neurologic practice, and only 2 fellowship programs specialize in sex- and gender-informed neurology nationally.

However, bans on abortion will immediately affect the delivery of current standard neurologic care for many patients, specifically standards that depend on planning or preventing pregnancies using individual choice.

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