Objective To describe Antiepileptic drug (AED) utilisation patterns before, during and after pregnancy in 7 population-based electronic healthcare databases. Methods A common protocol was implemented across 7 databases in Denmark, Norway, the Netherlands, Italy (Emilia Romagna/Tuscany), Wales, and the Clinical Practice Research Datalink representing the rest of the UK. Women with a pregnancy ending in a birth between 2004 and 2010 were identified in each database. All AED prescriptions issued (UK) or dispensed (non-UK) in the 6 months before, during or 6 months after pregnancy were identified. AED prescribing patterns were evaluated, including the prevalence of prescribing, the selection of AEDs, changes in prescribing over time and co-prescribing of folic acid. Results 966,649 women with 1,230,733 births were identified. Overall, during the 6 months before pregnancy, the prevalence of AED prescribing was 0.63% (CI950.61-0.64). During pregnancy this fell to 0.50% (CI950.49-0.51), ranging from 0.43% (CI950.33-0.54) in the Netherlands to 0.60% (CI950.54-0.66) in Wales. In all databases, prescribing declined during the first and second trimesters. In Denmark, Norway and the two UK databases lamotrigine was the AED most commonly prescribed, whereas in the Italian and Dutch databases the older AEDs including valproate, phenobarbital and carbamazepine were more frequently prescribed. A gradual increase in the use of lamotrigine was observed during the study period in Italy and the Netherlands. In all databases, less than a third of women prescribed AEDs during the 3 months before pregnancy were also prescribed high-dose folic acid (>0.5mg) during the same time period. Conclusion The regional differences in prescribing patterns suggest different use and interpretation of the scientific evidence base. The low co-prescribing of folic acid may indicate that many pregnancies are unplanned and women taking AEDs are not receiving complete preconception care.
Antiepileptic Drug Use before, during and after Pregnancy: A Study in 7 European Regions
Pierini Anna;
2014
Abstract
Objective To describe Antiepileptic drug (AED) utilisation patterns before, during and after pregnancy in 7 population-based electronic healthcare databases. Methods A common protocol was implemented across 7 databases in Denmark, Norway, the Netherlands, Italy (Emilia Romagna/Tuscany), Wales, and the Clinical Practice Research Datalink representing the rest of the UK. Women with a pregnancy ending in a birth between 2004 and 2010 were identified in each database. All AED prescriptions issued (UK) or dispensed (non-UK) in the 6 months before, during or 6 months after pregnancy were identified. AED prescribing patterns were evaluated, including the prevalence of prescribing, the selection of AEDs, changes in prescribing over time and co-prescribing of folic acid. Results 966,649 women with 1,230,733 births were identified. Overall, during the 6 months before pregnancy, the prevalence of AED prescribing was 0.63% (CI950.61-0.64). During pregnancy this fell to 0.50% (CI950.49-0.51), ranging from 0.43% (CI950.33-0.54) in the Netherlands to 0.60% (CI950.54-0.66) in Wales. In all databases, prescribing declined during the first and second trimesters. In Denmark, Norway and the two UK databases lamotrigine was the AED most commonly prescribed, whereas in the Italian and Dutch databases the older AEDs including valproate, phenobarbital and carbamazepine were more frequently prescribed. A gradual increase in the use of lamotrigine was observed during the study period in Italy and the Netherlands. In all databases, less than a third of women prescribed AEDs during the 3 months before pregnancy were also prescribed high-dose folic acid (>0.5mg) during the same time period. Conclusion The regional differences in prescribing patterns suggest different use and interpretation of the scientific evidence base. The low co-prescribing of folic acid may indicate that many pregnancies are unplanned and women taking AEDs are not receiving complete preconception care.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
