Antiepileptic drug prescribing before, during and after pregnancy: astudy in seven European regions

R Charlton, E Garne, H Wang, K Klungsoyr, S Jordan, A Neville, A Pierini, A Hansen, A Engeland, R Gini, D Thayer, J Bos, A Puccini, A-M Nybo Andersen, H Dolk, L de Jong van-den Berg

    Research output: Contribution to journalArticle

    20 Citations (Scopus)

    Abstract

    Purpose The aim of this study was to explore antiepileptic drug (AED) prescribing before, during and after pregnancy as recorded in sevenpopulation-based electronic healthcare databases.Methods Databases in Denmark, Norway, the Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the Clinical Practice ResearchDatalink, representing the rest of the UK, were accessed for the study. Women with a pregnancy starting and ending between 2004 and2010, which ended in a delivery, were identified. AED prescriptions issued (UK) or dispensed (non-UK) at any time during pregnancyand the 6 months before and after pregnancy were identified in each of the databases. AED prescribing patterns were analysed, and the choiceof AEDs and co-prescribing of folic acid were evaluated.Results In total, 978 957 women with 1 248 713 deliveries were identified. In all regions, AED prescribing declined during pregnancy andwas lowest during the third trimester, before returning to pre-pregnancy levels by 6 months following delivery. For all deliveries, the prev-alence of AED prescribing during pregnancy was 51 per 10 000 pregnancies (CI9549–52%) and was lowest in the Netherlands (43/10 000;CI9533–54%) and highest in Wales (60/10 000; CI9554–66%). In Denmark, Norway and the two UK databases lamotrigine was the mostcommonly prescribed AED; whereas in the Italian and Dutch databases, carbamazepine, valproate and phenobarbital were most frequentlyprescribed. Few women prescribed with AEDs in the 3 months before pregnancy were co-prescribed with high-dose folic acid: ranging from1.0% (CI950.3–1.8%) in Emilia Romagna to 33.5% (CI9528.7–38.4%) in Wales.Conclusion The country’s differences in prescribing patterns may suggest different use, knowledge or interpretation of the scientific evi-dence base. The low co-prescribing of folic acid indicates that more needs to be done to better inform clinicians and women of childbearingage taking AEDs about the need to offer and receive complete preconception care.
    LanguageEnglish
    Pages1144-1154
    JournalPharmacoepidemiology and Drug Safety
    Volume24
    Early online date13 Aug 2015
    DOIs
    Publication statusE-pub ahead of print - 13 Aug 2015

    Fingerprint

    Drug Prescriptions
    Anticonvulsants
    Pregnancy
    Databases
    Wales
    Folic Acid
    Denmark
    Norway
    Netherlands
    Preconception Care
    Carbamazepine
    Third Pregnancy Trimester
    Valproic Acid
    Phenobarbital
    Italy
    Delivery of Health Care

    Keywords

    • anticonvulsants
    • pregnancy
    • drug utilisation
    • electronic health records
    • pharmacoepidemiology

    Cite this

    Charlton, R., Garne, E., Wang, H., Klungsoyr, K., Jordan, S., Neville, A., ... de Jong van-den Berg, L. (2015). Antiepileptic drug prescribing before, during and after pregnancy: astudy in seven European regions. Pharmacoepidemiology and Drug Safety, 24, 1144-1154. https://doi.org/10.1002/pds.3847
    Charlton, R ; Garne, E ; Wang, H ; Klungsoyr, K ; Jordan, S ; Neville, A ; Pierini, A ; Hansen, A ; Engeland, A ; Gini, R ; Thayer, D ; Bos, J ; Puccini, A ; Nybo Andersen, A-M ; Dolk, H ; de Jong van-den Berg, L. / Antiepileptic drug prescribing before, during and after pregnancy: astudy in seven European regions. In: Pharmacoepidemiology and Drug Safety. 2015 ; Vol. 24. pp. 1144-1154.
    @article{313b5b5cad854eb8a185467993a9fe28,
    title = "Antiepileptic drug prescribing before, during and after pregnancy: astudy in seven European regions",
    abstract = "Purpose The aim of this study was to explore antiepileptic drug (AED) prescribing before, during and after pregnancy as recorded in sevenpopulation-based electronic healthcare databases.Methods Databases in Denmark, Norway, the Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the Clinical Practice ResearchDatalink, representing the rest of the UK, were accessed for the study. Women with a pregnancy starting and ending between 2004 and2010, which ended in a delivery, were identified. AED prescriptions issued (UK) or dispensed (non-UK) at any time during pregnancyand the 6 months before and after pregnancy were identified in each of the databases. AED prescribing patterns were analysed, and the choiceof AEDs and co-prescribing of folic acid were evaluated.Results In total, 978 957 women with 1 248 713 deliveries were identified. In all regions, AED prescribing declined during pregnancy andwas lowest during the third trimester, before returning to pre-pregnancy levels by 6 months following delivery. For all deliveries, the prev-alence of AED prescribing during pregnancy was 51 per 10 000 pregnancies (CI9549–52{\%}) and was lowest in the Netherlands (43/10 000;CI9533–54{\%}) and highest in Wales (60/10 000; CI9554–66{\%}). In Denmark, Norway and the two UK databases lamotrigine was the mostcommonly prescribed AED; whereas in the Italian and Dutch databases, carbamazepine, valproate and phenobarbital were most frequentlyprescribed. Few women prescribed with AEDs in the 3 months before pregnancy were co-prescribed with high-dose folic acid: ranging from1.0{\%} (CI950.3–1.8{\%}) in Emilia Romagna to 33.5{\%} (CI9528.7–38.4{\%}) in Wales.Conclusion The country’s differences in prescribing patterns may suggest different use, knowledge or interpretation of the scientific evi-dence base. The low co-prescribing of folic acid indicates that more needs to be done to better inform clinicians and women of childbearingage taking AEDs about the need to offer and receive complete preconception care.",
    keywords = "anticonvulsants, pregnancy, drug utilisation, electronic health records, pharmacoepidemiology",
    author = "R Charlton and E Garne and H Wang and K Klungsoyr and S Jordan and A Neville and A Pierini and A Hansen and A Engeland and R Gini and D Thayer and J Bos and A Puccini and {Nybo Andersen}, A-M and H Dolk and {de Jong van-den Berg}, L",
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    Charlton, R, Garne, E, Wang, H, Klungsoyr, K, Jordan, S, Neville, A, Pierini, A, Hansen, A, Engeland, A, Gini, R, Thayer, D, Bos, J, Puccini, A, Nybo Andersen, A-M, Dolk, H & de Jong van-den Berg, L 2015, 'Antiepileptic drug prescribing before, during and after pregnancy: astudy in seven European regions', Pharmacoepidemiology and Drug Safety, vol. 24, pp. 1144-1154. https://doi.org/10.1002/pds.3847

    Antiepileptic drug prescribing before, during and after pregnancy: astudy in seven European regions. / Charlton, R; Garne, E; Wang, H; Klungsoyr, K; Jordan, S; Neville, A; Pierini, A; Hansen, A; Engeland, A; Gini, R; Thayer, D; Bos, J; Puccini, A; Nybo Andersen, A-M; Dolk, H; de Jong van-den Berg, L.

    In: Pharmacoepidemiology and Drug Safety, Vol. 24, 13.08.2015, p. 1144-1154.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Antiepileptic drug prescribing before, during and after pregnancy: astudy in seven European regions

    AU - Charlton, R

    AU - Garne, E

    AU - Wang, H

    AU - Klungsoyr, K

    AU - Jordan, S

    AU - Neville, A

    AU - Pierini, A

    AU - Hansen, A

    AU - Engeland, A

    AU - Gini, R

    AU - Thayer, D

    AU - Bos, J

    AU - Puccini, A

    AU - Nybo Andersen, A-M

    AU - Dolk, H

    AU - de Jong van-den Berg, L

    PY - 2015/8/13

    Y1 - 2015/8/13

    N2 - Purpose The aim of this study was to explore antiepileptic drug (AED) prescribing before, during and after pregnancy as recorded in sevenpopulation-based electronic healthcare databases.Methods Databases in Denmark, Norway, the Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the Clinical Practice ResearchDatalink, representing the rest of the UK, were accessed for the study. Women with a pregnancy starting and ending between 2004 and2010, which ended in a delivery, were identified. AED prescriptions issued (UK) or dispensed (non-UK) at any time during pregnancyand the 6 months before and after pregnancy were identified in each of the databases. AED prescribing patterns were analysed, and the choiceof AEDs and co-prescribing of folic acid were evaluated.Results In total, 978 957 women with 1 248 713 deliveries were identified. In all regions, AED prescribing declined during pregnancy andwas lowest during the third trimester, before returning to pre-pregnancy levels by 6 months following delivery. For all deliveries, the prev-alence of AED prescribing during pregnancy was 51 per 10 000 pregnancies (CI9549–52%) and was lowest in the Netherlands (43/10 000;CI9533–54%) and highest in Wales (60/10 000; CI9554–66%). In Denmark, Norway and the two UK databases lamotrigine was the mostcommonly prescribed AED; whereas in the Italian and Dutch databases, carbamazepine, valproate and phenobarbital were most frequentlyprescribed. Few women prescribed with AEDs in the 3 months before pregnancy were co-prescribed with high-dose folic acid: ranging from1.0% (CI950.3–1.8%) in Emilia Romagna to 33.5% (CI9528.7–38.4%) in Wales.Conclusion The country’s differences in prescribing patterns may suggest different use, knowledge or interpretation of the scientific evi-dence base. The low co-prescribing of folic acid indicates that more needs to be done to better inform clinicians and women of childbearingage taking AEDs about the need to offer and receive complete preconception care.

    AB - Purpose The aim of this study was to explore antiepileptic drug (AED) prescribing before, during and after pregnancy as recorded in sevenpopulation-based electronic healthcare databases.Methods Databases in Denmark, Norway, the Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the Clinical Practice ResearchDatalink, representing the rest of the UK, were accessed for the study. Women with a pregnancy starting and ending between 2004 and2010, which ended in a delivery, were identified. AED prescriptions issued (UK) or dispensed (non-UK) at any time during pregnancyand the 6 months before and after pregnancy were identified in each of the databases. AED prescribing patterns were analysed, and the choiceof AEDs and co-prescribing of folic acid were evaluated.Results In total, 978 957 women with 1 248 713 deliveries were identified. In all regions, AED prescribing declined during pregnancy andwas lowest during the third trimester, before returning to pre-pregnancy levels by 6 months following delivery. For all deliveries, the prev-alence of AED prescribing during pregnancy was 51 per 10 000 pregnancies (CI9549–52%) and was lowest in the Netherlands (43/10 000;CI9533–54%) and highest in Wales (60/10 000; CI9554–66%). In Denmark, Norway and the two UK databases lamotrigine was the mostcommonly prescribed AED; whereas in the Italian and Dutch databases, carbamazepine, valproate and phenobarbital were most frequentlyprescribed. Few women prescribed with AEDs in the 3 months before pregnancy were co-prescribed with high-dose folic acid: ranging from1.0% (CI950.3–1.8%) in Emilia Romagna to 33.5% (CI9528.7–38.4%) in Wales.Conclusion The country’s differences in prescribing patterns may suggest different use, knowledge or interpretation of the scientific evi-dence base. The low co-prescribing of folic acid indicates that more needs to be done to better inform clinicians and women of childbearingage taking AEDs about the need to offer and receive complete preconception care.

    KW - anticonvulsants

    KW - pregnancy

    KW - drug utilisation

    KW - electronic health records

    KW - pharmacoepidemiology

    U2 - 10.1002/pds.3847

    DO - 10.1002/pds.3847

    M3 - Article

    VL - 24

    SP - 1144

    EP - 1154

    JO - Pharmacoepidemiology and Drug Safety

    T2 - Pharmacoepidemiology and Drug Safety

    JF - Pharmacoepidemiology and Drug Safety

    SN - 1053-8569

    ER -