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

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.