RT Journal Article
SR Electronic
T1 Prescribing Trends for Valproate Among Pregnant Women
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e2163
OP e2173
DO 10.1212/WNL.0000000000200260
VO 98
IS 21
A1 Degremont, Adeline
A1 Kerbrat, Sandrine
A1 Balusson, Frédéric
A1 Jonville-Bera, Annie Pierre
A1 Ringa, Virginie
A1 Travers, David
A1 Tillaut, Hélène
A1 Leray, Emmanuelle
A1 Oger, Emmanuel
A1 Biraben, Arnaud
A1 Polard, Elisabeth
YR 2022
UL http://n.neurology.org/content/98/21/e2163.abstract
AB Background and Objective To describe the prescribing trends for sodium valproate (VPA) and alternative drugs during and around pregnancy, comparing 2016 (after the recommendations on valproate for women were reinforced by the European Medicines Agency [EMA]) with 2013 (before the recommendations).Methods Using the French National Health Insurance Database, a cross-sectional study was carried out in 2013 and in 2016, including women who became pregnant and had at least 1 reimbursement claim for VPA in the 2 years prior to pregnancy or during pregnancy. Exposure to VPA and its alternatives was then measured for each quarter, in the 2 years before pregnancy (preconception), during pregnancy, and in the year after pregnancy (postpartum).Results Among pregnant women with epilepsy (n = 2,607 pregnancies), the proportion exposed to VPA during pregnancy decreased from 26.4% to 9.3% between 2013 and 2016, alongside an increase in lamotrigine and levetiracetam use. Among pregnant women with bipolar disorder (n = 4,278 pregnancies), the proportion of women exposed during pregnancy decreased from 3.7% in 2013 to 1.9% in 2016, without any switch to alternative drugs. In both populations, fewer than one third had consulted a specialist before pregnancy.Discussion As recommended by the EMA, a change in practice over the 2013–2016 period was observed, with fewer women exposed to VPA during pregnancy and before pregnancy. However, in 2016, a large number of women were exposed to VPA in the first trimester of pregnancy (n = 471), which could suggest that the timing of pregnancy should be better planned when possible.AED=antiepileptic drug; ANSM=Agence Nationale de Sécurité du Médicament; EMA=European Medicines Agency; GP=general practitioner; ICD-10=International Classification of Diseases, 10th revision; LEV=levetiracetam; LTG=lamotrigine; MSM=mood stabilizing medication; SNDS=French National Health Insurance Database; VPA=sodium valproate