title: Antiepileptic drugs during pregnancy in primary care: a UK population based study.
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.
authors.affiliation: Research Department of Primary Care and Population Health, University College London, London, United Kingdom. shuk-li.man.10@ucl.ac.uk
authors.forename: Shuk-Li
authors.initials: SL
authors.lastname: Man
authors.forename: Irene
authors.initials: I
authors.lastname: Petersen
authors.forename: Mary
authors.initials: M
authors.lastname: Thompson
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy; D015331:Cohort Studies; D004827:Epilepsy / Q000188:drug therapy; D005260:Female; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011247:Pregnancy; D011320:Primary Health Care
chemical_list: D000927:Anticonvulsants