Prescription of antiepileptic medicines including sodium valproate in pregnant women: a study in three European countries

Caroline Hurault-Delarue, Joan K Morris, Rachel Charlton, Rosa Gini, Maria Loane, Anna Pierini, Aurora Puccini, Amanda Neville, Julia Snowball, Christine Damase-Michel

Research output: Contribution to journalArticle

Abstract

Purpose

To study patterns of antiepileptic drugs (AED) prescribing, particularly valproate, during pregnancy over a 10‐year period in the UK, Italy, and France.

Methods

Data on pregnancies conceived after 1 January 2007 with outcomes before 31 December 2016 were extracted from four European electronic health care databases (380 499 in the United Kingdom (UK), 66 681 in France, and 649 918 in Italy [355 767 in Emilia Romagna and 294 151 in Tuscany]). Prevalence of AEDs with an ATC code starting N03A and clobazam (N05BA09) were stratified by country and calendar year.

Results

AED prescribing during pregnancy varied from 3.0 (2.8‐3.1) per 1000 pregnancies in Emilia Romagna to 7.8 (7.5‐8.0) in the UK, 5.9 (5.6‐6.1) in Tuscany, and 6.3 (5.7‐6.9) in France. Lamotrigine was commonly prescribed in all regions with a third of women exposed to an AED during pregnancy taking lamotrigine in the UK and France. Valproate was prescribed to 28.6% of AED exposed pregnant women in Tuscany, 21.6% in France, 16.7% in Emilia Romagna, and 11.9% in the UK. Over the study period, the prevalence of AED prescribing increased in the UK mainly due to increases in pregabalin and gabapentin, declined in France mainly related to decreases in clonazepam, and remained constant in Italy. Valproate prescriptions declined to a prevalence <1 per 1000 pregnancies in 2015 to 2016 in the UK, France, and Emilia Romagna.

Conclusions

Variations in AED prescribing during pregnancy indicate the potential for further reductions, particularly of valproate. Increases in pregabalin/gabapentin prescribing, for which risks are not well known, are a cause for concern.

LanguageEnglish
JournalPharmacoepidemiology and Drug Safety
Early online date13 Sep 2019
DOIs
Publication statusE-pub ahead of print - 13 Sep 2019

Fingerprint

Valproic Acid
Anticonvulsants
France
Prescriptions
Pregnant Women
Pregnancy
Drug Prescriptions
Italy
Clonazepam
United Kingdom
Databases
Delivery of Health Care

Keywords

  • Antiepileptic drugs
  • Linkage
  • Valproate
  • Europe
  • Pregnancy

Cite this

Hurault-Delarue, Caroline ; Morris, Joan K ; Charlton, Rachel ; Gini, Rosa ; Loane, Maria ; Pierini, Anna ; Puccini, Aurora ; Neville, Amanda ; Snowball, Julia ; Damase-Michel, Christine. / Prescription of antiepileptic medicines including sodium valproate in pregnant women: a study in three European countries. In: Pharmacoepidemiology and Drug Safety. 2019.
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title = "Prescription of antiepileptic medicines including sodium valproate in pregnant women: a study in three European countries",
abstract = "PurposeTo study patterns of antiepileptic drugs (AED) prescribing, particularly valproate, during pregnancy over a 10‐year period in the UK, Italy, and France.MethodsData on pregnancies conceived after 1 January 2007 with outcomes before 31 December 2016 were extracted from four European electronic health care databases (380 499 in the United Kingdom (UK), 66 681 in France, and 649 918 in Italy [355 767 in Emilia Romagna and 294 151 in Tuscany]). Prevalence of AEDs with an ATC code starting N03A and clobazam (N05BA09) were stratified by country and calendar year.ResultsAED prescribing during pregnancy varied from 3.0 (2.8‐3.1) per 1000 pregnancies in Emilia Romagna to 7.8 (7.5‐8.0) in the UK, 5.9 (5.6‐6.1) in Tuscany, and 6.3 (5.7‐6.9) in France. Lamotrigine was commonly prescribed in all regions with a third of women exposed to an AED during pregnancy taking lamotrigine in the UK and France. Valproate was prescribed to 28.6{\%} of AED exposed pregnant women in Tuscany, 21.6{\%} in France, 16.7{\%} in Emilia Romagna, and 11.9{\%} in the UK. Over the study period, the prevalence of AED prescribing increased in the UK mainly due to increases in pregabalin and gabapentin, declined in France mainly related to decreases in clonazepam, and remained constant in Italy. Valproate prescriptions declined to a prevalence <1 per 1000 pregnancies in 2015 to 2016 in the UK, France, and Emilia Romagna.ConclusionsVariations in AED prescribing during pregnancy indicate the potential for further reductions, particularly of valproate. Increases in pregabalin/gabapentin prescribing, for which risks are not well known, are a cause for concern.",
keywords = "Antiepileptic drugs, Linkage, Valproate, Europe, Pregnancy",
author = "Caroline Hurault-Delarue and Morris, {Joan K} and Rachel Charlton and Rosa Gini and Maria Loane and Anna Pierini and Aurora Puccini and Amanda Neville and Julia Snowball and Christine Damase-Michel",
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Hurault-Delarue, C, Morris, JK, Charlton, R, Gini, R, Loane, M, Pierini, A, Puccini, A, Neville, A, Snowball, J & Damase-Michel, C 2019, 'Prescription of antiepileptic medicines including sodium valproate in pregnant women: a study in three European countries', Pharmacoepidemiology and Drug Safety. https://doi.org/10.1002/pds.4897

Prescription of antiepileptic medicines including sodium valproate in pregnant women: a study in three European countries. / Hurault-Delarue, Caroline; Morris, Joan K; Charlton, Rachel; Gini, Rosa; Loane, Maria; Pierini, Anna ; Puccini, Aurora; Neville, Amanda; Snowball, Julia; Damase-Michel, Christine.

In: Pharmacoepidemiology and Drug Safety, 13.09.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prescription of antiepileptic medicines including sodium valproate in pregnant women: a study in three European countries

AU - Hurault-Delarue, Caroline

AU - Morris, Joan K

AU - Charlton, Rachel

AU - Gini, Rosa

AU - Loane, Maria

AU - Pierini, Anna

AU - Puccini, Aurora

AU - Neville, Amanda

AU - Snowball, Julia

AU - Damase-Michel, Christine

PY - 2019/9/13

Y1 - 2019/9/13

N2 - PurposeTo study patterns of antiepileptic drugs (AED) prescribing, particularly valproate, during pregnancy over a 10‐year period in the UK, Italy, and France.MethodsData on pregnancies conceived after 1 January 2007 with outcomes before 31 December 2016 were extracted from four European electronic health care databases (380 499 in the United Kingdom (UK), 66 681 in France, and 649 918 in Italy [355 767 in Emilia Romagna and 294 151 in Tuscany]). Prevalence of AEDs with an ATC code starting N03A and clobazam (N05BA09) were stratified by country and calendar year.ResultsAED prescribing during pregnancy varied from 3.0 (2.8‐3.1) per 1000 pregnancies in Emilia Romagna to 7.8 (7.5‐8.0) in the UK, 5.9 (5.6‐6.1) in Tuscany, and 6.3 (5.7‐6.9) in France. Lamotrigine was commonly prescribed in all regions with a third of women exposed to an AED during pregnancy taking lamotrigine in the UK and France. Valproate was prescribed to 28.6% of AED exposed pregnant women in Tuscany, 21.6% in France, 16.7% in Emilia Romagna, and 11.9% in the UK. Over the study period, the prevalence of AED prescribing increased in the UK mainly due to increases in pregabalin and gabapentin, declined in France mainly related to decreases in clonazepam, and remained constant in Italy. Valproate prescriptions declined to a prevalence <1 per 1000 pregnancies in 2015 to 2016 in the UK, France, and Emilia Romagna.ConclusionsVariations in AED prescribing during pregnancy indicate the potential for further reductions, particularly of valproate. Increases in pregabalin/gabapentin prescribing, for which risks are not well known, are a cause for concern.

AB - PurposeTo study patterns of antiepileptic drugs (AED) prescribing, particularly valproate, during pregnancy over a 10‐year period in the UK, Italy, and France.MethodsData on pregnancies conceived after 1 January 2007 with outcomes before 31 December 2016 were extracted from four European electronic health care databases (380 499 in the United Kingdom (UK), 66 681 in France, and 649 918 in Italy [355 767 in Emilia Romagna and 294 151 in Tuscany]). Prevalence of AEDs with an ATC code starting N03A and clobazam (N05BA09) were stratified by country and calendar year.ResultsAED prescribing during pregnancy varied from 3.0 (2.8‐3.1) per 1000 pregnancies in Emilia Romagna to 7.8 (7.5‐8.0) in the UK, 5.9 (5.6‐6.1) in Tuscany, and 6.3 (5.7‐6.9) in France. Lamotrigine was commonly prescribed in all regions with a third of women exposed to an AED during pregnancy taking lamotrigine in the UK and France. Valproate was prescribed to 28.6% of AED exposed pregnant women in Tuscany, 21.6% in France, 16.7% in Emilia Romagna, and 11.9% in the UK. Over the study period, the prevalence of AED prescribing increased in the UK mainly due to increases in pregabalin and gabapentin, declined in France mainly related to decreases in clonazepam, and remained constant in Italy. Valproate prescriptions declined to a prevalence <1 per 1000 pregnancies in 2015 to 2016 in the UK, France, and Emilia Romagna.ConclusionsVariations in AED prescribing during pregnancy indicate the potential for further reductions, particularly of valproate. Increases in pregabalin/gabapentin prescribing, for which risks are not well known, are a cause for concern.

KW - Antiepileptic drugs

KW - Linkage

KW - Valproate

KW - Europe

KW - Pregnancy

U2 - 10.1002/pds.4897

DO - 10.1002/pds.4897

M3 - Article

JO - Pharmacoepidemiology and Drug Safety

T2 - Pharmacoepidemiology and Drug Safety

JF - Pharmacoepidemiology and Drug Safety

SN - 1053-8569

ER -