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. 2025 Aug;15(4):e200485.
doi: 10.1212/CPJ.0000000000200485. Epub 2025 Jun 4.

Improving Folic Acid Supplementation for Women of Childbearing Age With Epilepsy

Kimberly Anne Ndahayo  1 , Teresa Connolly  2 , Jennifer R Simpson  1 , Ashley Baranoff  1 , Jacob Pellinen  1
Affiliations

Improving Folic Acid Supplementation for Women of Childbearing Age With Epilepsy

Kimberly Anne Ndahayo et al. Neurol Clin Pract. 2025 Aug.

Abstract

Background and objectives: Birth complications such as autism and neurodevelopmental disabilities have an increased incidence in women with epilepsy (WWE), associated with the use of antiseizure medications, which can be mitigated with folic acid supplementation. This quality improvement (QI) project aimed to increase folic acid prescription rates from 18% to 50% for WWE between ages 18 and 47 seen at a level 4 epilepsy center.

Methods: Data from the electronic health record (EHR) were obtained for women meeting inclusion criteria and were analyzed using descriptive statistics and QI methods. Four Plan-Do-Study-Act cycles were conducted during the intervention phase including provider education, implementation of an EHR screening tool, introducing patient educational flyers into clinic rooms, and reporting provider data to improve awareness of prescribing barriers.

Results: Baseline data were collected from January through June 2022, identifying 1,032 patients meeting inclusion criteria. Interventions began in July 2022 and concluded in March 2023 during which time 1,252 patients met inclusion criteria. Folic acid prescription rates for WWE of childbearing age were increased from a baseline of 17.37% to 35.03%. Folic acid prescribing increased throughout the intervention phases. Improving provider awareness of their own prescribing habits along with educational interventions had the largest impact on increasing prescribing rates. All providers effectively received the initial educational intervention.

Discussion: This QI study demonstrated that increasing provider education and awareness of current clinical practice guidelines increases folic acid prescribing rates for WWE of childbearing age without negatively affecting clinical workflow. This highlights the importance of provider education and ongoing monitoring of folic acid prescribing rates to improve patient outcomes and identifies a series of interventions that can be replicated in a variety of clinical settings.

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Conflict of interest statement

The authors report no relevant disclosures. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.TAKE-HOME POINTS→ Data demonstrated a positive shift of 17.66% during the study period, which was an increase in the folic acid prescribing rate from 17.37% to 35.03%.→ Key findings suggest that provider education along with awareness of individual prescribing habits correlated with increased folic acid prescribing rates, highlighting the importance of provider education and ongoing monitoring of folic acid prescribing rates to improve patient outcomes.→ Balancing measure indicated that no negative impacts were identified by providers throughout these interventions.→ Improving folic acid prescribing rates aligns with current CPGs, and steps taken through this QI project can be replicated and implemented in similar clinical settings to continue to target this goal among this patient population.

References

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