Counseling Adolescents About Reproductive Health and Epilepsy (CARE): Optimization and Feasibility Testing of a Multi-Level Intervention

Reproductive-age youth with epilepsy (RAYE) are at risk for adverse reproductive health outcomes. Certain antiseizure medications (ASMs) reduce the efficacy of some contraceptives and some ASMs adversely affect fetal development. Unplanned compared to planned pregnancy among people with epilepsy has been associated with increased rates of pre-term birth, congenital malformations, and seizures during pregnancy. Information about planning pregnancy, including use of contraception, is especially crucial for youth, who are at higher risk of unplanned pregnancy than adults. RAYE are also more than twice as likely to be prescribed teratogenic ASMs as adults over 24 years old. As reproductive health education is known to lead to better reproductive health outcomes for adolescents, informing RAYE about reproductive health and epilepsy is imperative. An important strategy to educate RAYE about epilepsy and reproductive health is through child neurology clinicians. My prior work found that RAYE and caregivers want epilepsy-related reproductive health counseling from child neurology clinicians, as is recommended by the American Academy of Neurology and Child Neurology Foundation. Yet my research has indicated that child neurology clinicians often omit this counseling or miscommunicate key messages. To address these challenges, I have developed a prototype of a multi-level intervention: Counseling Adolescents about Reproductive Health and Epilepsy (CARE). CARE combines 1) child neurology clinician online counseling skills training, 2) follow- up Short Messaging Service (SMS) messages for RAYE, and 3) SMS messages for caregivers to empower them to reinforce healthy behaviors. Through this proposed project, I will 1. optimize CARE with input from key stakeholders (clinicians, RAYE, and caregivers), 2. test the feasibility of CARE through a pilot trial, and 3. assess determinants of implementation of CARE through follow-up qualitative interviews with trial participants (clinicians, RAYE, and caregivers). These aims will provide the foundation for a future R01 application for a multi- center cluster-randomized controlled trial to test the clinical efficacy of CARE. This K23 proposal will support career development objectives in engaging adolescents in research, intervention development, conducting clinical trials, and implementation science. This grant will prepare me to become an independent investigator focused on optimizing the reproductive health of RAYE. Project Number: 1K23NS144711-01A1 | Fiscal Year: 2026 | NIH Institute/Center: National Institute of Neurological Disorders and Stroke (NINDS) | Principal Investigator: Laura Kirkpatrick | Institution: UNIVERSITY OF PITTSBURGH AT PITTSBURGH, PITTSBURGH, PA | Award Amount: $225,314 | Activity Code: K23 | Study Section: Interdisciplinary Clinical Care in Specialty Care Settings Study Section[ICSC] View on NIH RePORTER: https://reporter.nih.gov/project-details/11370047