title: Antiepileptic drug use by pregnant women enrolled in Florida Medicaid.
abstract: OBJECTIVE
  The study aims were to investigate secular trends in antiepileptic drug (AED) use in women during pregnancy, and to compare the use of first- and second-generation AEDs.
  
  
  METHODS
  Study participants consisted of female Florida Medicaid beneficiaries, older than 15 years, and pregnant within the time period 1999 to 2009. Fifteen AEDs were categorized into first and second generation of AEDs. Continuous use of AEDs was defined as at least 2 consecutive AED prescriptions totaling more than a 30-day supply. Polytherapy was defined as 2 or more AEDs continuously used for at least 30 overlapping days. Annual prevalence was estimated and compared.
  
  
  RESULTS
  We included 2,099 pregnant women who were enrolled in Florida Medicaid from 1999 to 2009 and exposed to AEDs during pregnancy. Although there were fluctuations, overall AED use in the study cohort did not increase from 2000 to 2009 (β ± standard error [SE]: -0.07 ± 0.06, p = 0.31). The use of first-generation AEDs decreased (β ± SE: -6.21 ± 0.47, p < 0.0001), whereas the use of second-generation AEDs increased (β ± SE: 6.27 ± 0.52, p < 0.0001) from 2000 to 2009. AED use in polytherapy did not change through the study period. Valproate use reduced from 23% to 8% in the study population (β ± SE: -1.61 ± 0.36, p = 0.0019), but this decrease was only for women receiving an AED for epilepsy and was not present for other indications.
  
  
  CONCLUSIONS
  The second-generation AEDs are replacing first-generation AEDs in both monotherapy and polytherapy. Valproate use has declined for epilepsy but not other indications. Additional changes in AED use are expected in future years.
authors: From the Department of Medicine (X.W.), and Department of Pharmaceutical Outcomes and Policy, College of Pharmacy (A.H.), University of Florida, Gainesville; and Department of Neurology & Neurological Sciences (K.J.M.), Stanford University, CA. xuerong.wen@medicine.ufl.edu.
authors: Xuerong
authors: X
authors: Wen
authors: From the Department of Medicine (X.W.), and Department of Pharmaceutical Outcomes and Policy, College of Pharmacy (A.H.), University of Florida, Gainesville; and Department of Neurology & Neurological Sciences (K.J.M.), Stanford University, CA.
authors: Kimford J
authors: KJ
authors: Meador
authors: From the Department of Medicine (X.W.), and Department of Pharmaceutical Outcomes and Policy, College of Pharmacy (A.H.), University of Florida, Gainesville; and Department of Neurology & Neurological Sciences (K.J.M.), Stanford University, CA.
authors: Abraham
authors: A
authors: Hartzema
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D015331:Cohort Studies; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D008484:Medicaid; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
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