Jacqueline M Cohen1, Carolyn E Cesta2, Kari Furu1,3, Kristjana Einarsdóttir4, Mika Gissler5,6,7, Alys Havard8, Sonia Hernandez-Diaz9, Krista F Huybrechts10, Helle Kieler2,11, Maarit K Leinonen5, Jiong Li12, Johan Reutfors2, Andrea Schaffer8, Randi Selmer1, Yongfu Yu12, Helga Zoega4,8, Øystein Karlstad1. 1. Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway. 2. Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. 3. Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway. 4. Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 5. Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland. 6. Research Centre for Child Psychiatry, University of Turku, Turku, Finland. 7. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. 8. Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia. 9. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. 10. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. 11. Department for Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. 12. Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.
Abstract
PURPOSE: To describe recent international trends in antiepileptic drug (AED) use during pregnancy and individual patterns of use including discontinuation and switching. METHODS: We studied pregnancies from 2006 to 2016 within linked population-based registers for births and dispensed prescription drugs from Denmark, Finland, Iceland, Norway, Sweden, and New South Wales, Australia and claims data for public and private insurance enrollees in the United States. We examined the prevalence of AED use: the proportion of pregnancies with ≥1 prescription filled from 3 months before pregnancy until birth, and individual patterns of use by trimester. RESULTS: Prevalence of AED use in almost five million pregnancies was 15.3 per 1000 (n = 75 249) and varied from 6.4 in Sweden to 34.5 per 1000 in the publicly-insured US population. AED use increased in all countries in 2006-2012 ranging from an increase of 22% in Australia to 104% in Sweden, and continued to rise or stabilized in the countries in which more recent data were available. Lamotrigine, clonazepam, and valproate were the most commonly used AEDs in the Nordic countries, United States, and Australia, respectively. Among AED users, 31% only filled a prescription in the 3 months before pregnancy. Most filled a prescription in the first trimester (59%) but few filled prescriptions in every trimester (22%). CONCLUSIONS: Use of AEDs in pregnancy rose from 2006 to 2016. Trends and patterns of use of valproate and lamotrigine reflected the safety data available during this period. Many women discontinued AEDs during pregnancy while some switched to another AED.
PURPOSE: To describe recent international trends in antiepileptic drug (AED) use during pregnancy and individual patterns of use including discontinuation and switching. METHODS: We studied pregnancies from 2006 to 2016 within linked population-based registers for births and dispensed prescription drugs from Denmark, Finland, Iceland, Norway, Sweden, and New South Wales, Australia and claims data for public and private insurance enrollees in the United States. We examined the prevalence of AED use: the proportion of pregnancies with ≥1 prescription filled from 3 months before pregnancy until birth, and individual patterns of use by trimester. RESULTS: Prevalence of AED use in almost five million pregnancies was 15.3 per 1000 (n = 75 249) and varied from 6.4 in Sweden to 34.5 per 1000 in the publicly-insured US population. AED use increased in all countries in 2006-2012 ranging from an increase of 22% in Australia to 104% in Sweden, and continued to rise or stabilized in the countries in which more recent data were available. Lamotrigine, clonazepam, and valproate were the most commonly used AEDs in the Nordic countries, United States, and Australia, respectively. Among AED users, 31% only filled a prescription in the 3 months before pregnancy. Most filled a prescription in the first trimester (59%) but few filled prescriptions in every trimester (22%). CONCLUSIONS: Use of AEDs in pregnancy rose from 2006 to 2016. Trends and patterns of use of valproate and lamotrigine reflected the safety data available during this period. Many women discontinued AEDs during pregnancy while some switched to another AED.
Authors: Sallie-Anne Pearson; Nicole Pratt; Juliana de Oliveira Costa; Helga Zoega; Tracey-Lea Laba; Christopher Etherton-Beer; Frank M Sanfilippo; Alice Morgan; Lisa Kalisch Ellett; Claudia Bruno; Erin Kelty; Maarten IJzerman; David B Preen; Claire M Vajdic; David Henry Journal: Int J Environ Res Public Health Date: 2021-12-18 Impact factor: 3.390