Antiepileptic drug prescribing before, during and after pregnancy: a study in seven European regions.
OBJECTIVE
The aim of this study was to explore antiepileptic drug (AED) prescribing before, during and after pregnancy as recorded in seven population-based electronic healthcare databases.


METHODS
Databases in Denmark, Norway, the Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the Clinical Practice Research Datalink, representing the rest of the UK, were accessed for the study. Women with a pregnancy starting and ending between 2004 and 2010, which ended in a delivery, were identified. AED prescriptions issued (UK) or dispensed (non-UK) at any time during pregnancy and the 6 months before and after pregnancy were identified in each of the databases. AED prescribing patterns were analysed, and the choice of AEDs and co-prescribing of folic acid were evaluated.


RESULTS
In total, 978 957 women with 1 248 713 deliveries were identified. In all regions, AED prescribing declined during pregnancy and was lowest during the third trimester, before returning to pre-pregnancy levels by 6 months following delivery. For all deliveries, the prevalence of AED prescribing during pregnancy was 51 per 10 000 pregnancies (CI95 49-52%) and was lowest in the Netherlands (43/10 000; CI95 33-54%) and highest in Wales (60/10 000; CI95 54-66%). In Denmark, Norway and the two UK databases lamotrigine was the most commonly prescribed AED; whereas in the Italian and Dutch databases, carbamazepine, valproate and phenobarbital were most frequently prescribed. Few women prescribed with AEDs in the 3 months before pregnancy were co-prescribed with high-dose folic acid: ranging from 1.0% (CI95 0.3-1.8%) in Emilia Romagna to 33.5% (CI95 28.7-38.4%) in Wales.


CONCLUSIONS
The country's differences in prescribing patterns may suggest different use, knowledge or interpretation of the scientific evidence base. The low co-prescribing of folic acid indicates that more needs to be done to better inform clinicians and women of childbearing age taking AEDs about the need to offer and receive complete preconception care.
Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.
Rachel
R
Charlton
Paediatric department, Hospital Lillebaelt, Kolding, Denmark.
Ester
E
Garne
Pharmacoepidemiology and Pharmacoeconomics unit, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
Hao
H
Wang
Medical Birth Registry of Norway, The Norwegian Institute of Public Health, Bergen, Norway.|Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Kari
K
Klungsøyr
Department of Nursing, College of Human and Health Sciences, Swansea University, Swansea, Wales, UK.
Sue
S
Jordan
IMER (Emilia Romagna Registry of Birth Defects), Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy.
Amanda
A
Neville
Institute of Clinical Physiology - National Research Council (IFC-CNR), Pisa, Italy.
Anna
A
Pierini
Paediatric department, Hospital Lillebaelt, Kolding, Denmark.|Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Anne
A
Hansen
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.|Department of Pharmacoepidemiology, The Norwegian Institution of Public Health, Oslo, Norway.
Anders
A
Engeland
The Regional Agency for Public Health of Tuscany, Tuscany, Italy.
Rosa
R
Gini
Centre for Health Information, Research and Evaluation, Swansea University, Swansea, Wales, UK.
Daniel
D
Thayer
Pharmacoepidemiology and Pharmacoeconomics unit, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
Jens
J
Bos
Drug Policy Service, Emilia Romagna Region Health Authority, Bologna, Italy.
Aurora
A
Puccini
Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Anne-Marie
AM
Nybo Andersen
Institute of Nursing, University of Ulster, Ulster, Northern Ireland, United Kingdom.
Helen
H
Dolk
Pharmacoepidemiology and Pharmacoeconomics unit, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
Lolkje
L
de Jong-van den Berg
D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D005060:Europe; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D049590:Postpartum Period; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D016742:Preconception Care / Q000592:standards*; D011247:Pregnancy; D055815:Young Adult
D000927:Anticonvulsants; D005492:Folic Acid
anticonvulsants; drug utilisation; electronic health records; pharmacoepidemiology; pregnancy