Abortion Ban Could Be Life-Threatening for Women With Neurological Conditions

There are real dangers that reproductive-age women with multiple sclerosis (MS), migraines, and epilepsy face due to the dissolution of Roe v. Wade, according to neurologists from UC San Francisco in a perspective article published in JAMA Neurology on July 13, 2022.¹

"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," said Sara LaHue, MD, of the UCSF Department of Neurology, Weill Institute for Neurosciences, and corresponding author. "This could increase risk of morbidity, mortality, and irreversible disability accumulation for women with neurologic diseases."¹

Teratogenic drugs are drugs linked to birth defects in a developing embryo and fetus. Drugs including methotrexate and mycophenolate mofetil (CellCept; Genentech USA, Inc), which are neurological treatments for MS and myasthenia gravis, are teratogenic. With the abortion bans and the potential for severe restrictions relating to reproductive health in many states resulting from overturning of Roe v. Wade, some women have reportedly been denied access to these life-saving drugs, according to LaHue.¹

Studies have also found that people with disabilities, whether psychiatric, chronic, or physical, have higher rates of unplanned pregnancies and a higher risk of death during pregnancy than those without disabilities. According to Robyn Powell, an associate law professor at the University of Oklahoma, restrictions on abortions for any reason disproportionately harms disabled people.²

Furthermore, women with epilepsy are at an increased risk of having their health harmed as a result of Roe v. Wade being overturned. Their risk of death during pregnancy is 10 times greater than someone without it, explained Jacqueline French, co-director of epilepsy clinical trials for NYU Langone Health’s Comprehensive Epilepsy Center.²

Co-author Riley Bove, MD, MSc, of the UCSF Department of Neurology and the Weill Institute for Neurosciences, explained further that women with MS who live in certain states where they are now unable to access teratogenic drugs are treated with safer, but less effective drugs for their condition.¹

"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," said Bove.¹

Monoclonal antibodies are a significant therapy for MS, migraine, and myasthenia gravis patients, but they could also be teratogenic. The authors admitted that some neurologists could stop treating any woman of reproductive age with these medications, notwithstanding if she plans on becoming pregnant or not.¹

The authors noted in the article that reproductive health is integral to equitable delivery of neurologic care. Further, the investigators explained that the 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, fetus, or both are all examples of ways to ensure there is representative equity in care.¹

References

1. Abortion ban may mean denial of effective drugs for women with MS, migraine, epilepsy. ScienceDaily. July 13, 2022. Accessed July 26, 2022. https://www.sciencedaily.com/releases/2022/07/220713163355.htm
2. Venkatearamanan, Meena. People with disabilities weigh medication, pregnancy in post-Roe world. The Washington Post. July 25, 2022. Accessed July 26, 2022. https://www.washingtonpost.com/health/2022/07/25/disabled-people-abortion-restrictions/