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Prevalence trends and individual patterns of antiepileptic drug use in pregnancy 2006-2016: A study in the five Nordic countries, United States, and Australia

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DOI

  • Jacqueline M Cohen, Norwegian Institute of Public Health
  • ,
  • Carolyn E Cesta, Karolinska Univ Hosp, Karolinska Institutet, Karolinska University Hospital
  • ,
  • Kari Furu, Norwegian Institute of Public Health
  • ,
  • Kristjana Einarsdóttir, Univ Iceland, Landspitali National University Hospital, University of Iceland, Natl Univ Hosp Iceland
  • ,
  • Mika Gissler, Finnish Institute for Health and Welfare
  • ,
  • Alys Havard, Neuroscience Research Australia, Sydney, Australia.
  • ,
  • Sonia Hernandez-Diaz, Harvard TH Chan Sch Publ Hlth, Harvard T.H. Chan School of Public Health
  • ,
  • Krista F Huybrechts, Harvard Medical School / Brigham and Women's Hospital
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  • Helle Kieler, Karolinska Univ Hosp, Karolinska Institutet, Karolinska University Hospital
  • ,
  • Maarit K Leinonen, Finnish Institute for Health and Welfare
  • ,
  • Jiong Li
  • Johan Reutfors, Karolinska Univ Hosp, Karolinska Institutet, Karolinska University Hospital
  • ,
  • Andrea Schaffer, Neuroscience Research Australia, Sydney, Australia.
  • ,
  • Randi Selmer, Norwegian Institute of Public Health
  • ,
  • Yongfu Yu
  • Helga Zoega, Univ Iceland, Landspitali National University Hospital, University of Iceland, Natl Univ Hosp Iceland
  • ,
  • Øystein Karlstad, Norwegian Institute of Public Health

PURPOSE: To describe recent international trends in antiepileptic drug (AED) use during pregnancy and individual patterns of use including discontinuation and switching.

METHODS: We studied pregnancies from 2006 to 2016 within linked population-based registers for births and dispensed prescription drugs from Denmark, Finland, Iceland, Norway, Sweden, and New South Wales, Australia and claims data for public and private insurance enrollees in the United States. We examined the prevalence of AED use: the proportion of pregnancies with ≥1 prescription filled from 3 months before pregnancy until birth, and individual patterns of use by trimester.

RESULTS: Prevalence of AED use in almost five million pregnancies was 15.3 per 1000 (n = 75 249) and varied from 6.4 in Sweden to 34.5 per 1000 in the publicly-insured US population. AED use increased in all countries in 2006-2012 ranging from an increase of 22% in Australia to 104% in Sweden, and continued to rise or stabilized in the countries in which more recent data were available. Lamotrigine, clonazepam, and valproate were the most commonly used AEDs in the Nordic countries, United States, and Australia, respectively. Among AED users, 31% only filled a prescription in the 3 months before pregnancy. Most filled a prescription in the first trimester (59%) but few filled prescriptions in every trimester (22%).

CONCLUSIONS: Use of AEDs in pregnancy rose from 2006 to 2016. Trends and patterns of use of valproate and lamotrigine reflected the safety data available during this period. Many women discontinued AEDs during pregnancy while some switched to another AED.

Original languageEnglish
JournalPharmacoepidemiology and Drug Safety
Volume29
Issue8
Pages (from-to)913-922
Number of pages10
ISSN1053-8569
DOIs
Publication statusPublished - 2020

Bibliographical note

© 2020 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.

    Research areas

  • BIPOLAR DISORDER, EXPOSURE, MANAGEMENT, MEDICATION, RISK, WOMEN, antiepileptics, drug utilization, pharmacoepidemiology, population registers, pregnancy, valproate

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