title: The prescribing of antiepileptic drugs for pregnant Australian women.
abstract: BACKGROUND
  It is not clear how widely it is appreciated in Australia that certain antiepileptic drugs, particularly valproate, are teratogenic.
  
  
  OBJECTIVE
  The aim of the study is to assess trends in the pattern of antiepileptic drug prescribing for pregnant women in Australia to determine whether drug use is optimal, particularly from the fetal viewpoint.
  
  
  METHODS
  Analysis of data contained in the Australian Register of Antiepileptic Drugs, assessing trends in antiepileptic drug use correlated with pregnancy outcomes.
  
  
  RESULTS
  Valproate was the only significant teratogen among the antiepileptic drugs in common use. There was a fetal malformation rate of 14.5% associated with its use in monotherapy, as compared with a rate of 3.15% in antiepileptic drug-unexposed pregnancies in women with epilepsy (OR = 5.23, 95% CI = 1.81, 15.09). The highest malformation rate associated with any other antiepileptic drug used in monotherapy was 5.0%, for carbamazepine. Neurologists had progressively prescribed valproate less frequently and in lower dosage than other classes of practitioner over the 10-year study period, with a parallel decrease in occurrence of fetal malformations in pregnancies referred to the Register. Other prescribers of valproate did not seem to have adopted these practices to the same extent and had not obtained similar degrees of reduction in the occurrence of fetal malformations.
  
  
  CONCLUSIONS
  Contemporary Australian obstetricians, even though they may not be valproate prescribers, when managing pregnancies in women taking valproate, need to be alert to the possibility that it may not be being used optimally from the fetal point of view, especially when not prescribed by neurologists.
authors.affiliation: Department of Medicine and Neurosciences, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia. vajda@netspace.net.au
authors.forename: Frank J E
authors.initials: FJ
authors.lastname: Vajda
authors.forename: David
authors.initials: D
authors.lastname: Horgan
authors.forename: Samantha
authors.initials: S
authors.lastname: Hollingworth
authors.forename: Janet
authors.initials: J
authors.lastname: Graham
authors.forename: Alison A
authors.initials: AA
authors.lastname: Hitchcock
authors.forename: Annie
authors.initials: A
authors.lastname: Roten
authors.forename: Terence J
authors.initials: TJ
authors.lastname: O'Brien
authors.forename: Cecile M
authors.initials: CM
authors.lastname: Lander
authors.forename: Mervyn J
authors.initials: MJ
authors.lastname: Eadie
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000453:epidemiology*; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005333:Fetus / Q000002:abnormalities*; D006801:Humans; D016015:Logistic Models; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology; D012042:Registries; D018570:Risk Assessment; D014635:Valproic Acid / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid