The U.S. Supreme Court’s ruling to overturn Roe v Wade may mean that women with common neurological conditions such as migraine, epilepsy, and multiple sclerosis can be denied access to effective drugs, researchers at the University of California, San Francisco (UCSF) say.
In their perspective article, published in Jama Neurology, UCSF researchers write that these neurological conditions disproportionately affect women of reproductive age. They are often treated with teratogenic drugs, that have not been shown to be safe during pregnancy, and 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 the 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 UCSF Weill Institute for Neurosciences.
According to the authors, women with such neurological conditions as epilepsy face an increased likelihood of unplanned pregnancy because 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 multiple sclerosis 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,” LaHue says.
The 2003 National Health Interview Survey showed that migraine affected 8.6% of males and 17.5% of females in the U.S.
In 2015, more than three million people in the U.S. had active epilepsy, and nearly one million adults were living with multiple sclerosis in 2017.
According to LaHue, 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,” she said, referring to status epilepticus, encephalitis and vasculitis.
Last month the Supreme Court officially reversed Roe v. Wade, ruling that established the constitutional right to abortion, which is now banned or heavily restricted in at least 12 states.
1. The University of California, San Francisco (UCSF). Abortion Ban May Mean Denial of Effective Drugs for Women with MS, Migraine, Epilepsy.
2. JAMA Neurology. Reproductive Rights in Neurology—The Supreme Court's Impact on All of Us.
3. National Library of Medicine. Migraine prevalence by age and sex in the United States: a life-span study.
5. CDC. Epilepsy Fast Facts.
6. National Multiple Slecoris Society. Landmark Study Estimates Nearly 1 Million in the U.S. Have Multiple Sclerosis.