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Antiepileptic drugs during pregnancy in primary care: a UK population based study.

Man, SL; Petersen, I; Thompson, M; Nazareth, I; (2012) Antiepileptic drugs during pregnancy in primary care: a UK population based study. PLoS One , 7 (12) , Article e52339. 10.1371/journal.pone.0052339. Green open access

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Abstract

Objective Antiepileptic drugs (AEDs) are commonly prescribed for epilepsy and bipolar disorder but little is known about their use in pregnancy. We examined secular trends in AED prescribing in pregnancy and pregnancy as a determinant for stopping AED prescribing. Methods We identified 174,055 pregnancies from The Health Improvement Network UK primary care database. Secular trends in AED prescribing during pregnancy were examined between 1994 and 2009. We used Cox's regression analyses to compare time to discontinuation of AED prescriptions between pregnant and non-pregnant women and to identify predictors of discontinuation of AEDs in pregnancy. Results Prescribing of carbamazepine and sodium valproate have declined since 1994 despite being the most commonly prescribed AEDs in pregnancy up to 2004. Prescribing of lamotrigine in pregnancy has steadily increased and has been the most popular AED prescribed in pregnancy since 2004. Pregnant women with epilepsy were twice as likely to stop receiving AEDs (Hazard Ratio (HR) 2.00, 95% Confidence Interval (CI) 1.62–2.47) when compared to non-pregnant women and for women with bipolar disorder this was even higher (HR 3.07, 95% CI 2.04–4.62). For pregnant women with epilepsy, those receiving AEDs less regularly before pregnancy were more likely to stop receiving AEDs in pregnancy. Conclusions Lamotrigine has been increasingly prescribed in pregnancy over older AEDs namely carbamazepine and sodium valproate. Pregnancy is a strong determinant for the discontinuation of AED prescribing particularly for women with bipolar disorder.

Type: Article
Title: Antiepileptic drugs during pregnancy in primary care: a UK population based study.
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1371/journal.pone.0052339
Publisher version: http://dx.doi.org/10.1371/journal.pone.0052339
Language: English
Additional information: © 2012 Man et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This work is funded by the Medical Research Council UK and Cegedim Strategic Data. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Dr. Shuk-Li Man's PhD is largely funded by the Medical Research Council, UK, but the authors also receive commercial funding for this research from Cegedim Strategic Data Medical Research UK, and Dr. Mary Thompson is also employed by Cegedim Strategic Data Medical Research UK. The authors declare that this does not alter their adherence to all the PLOS ONE policies on sharing data and materials.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1381494
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