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. 2012;7(12):e52339.
doi: 10.1371/journal.pone.0052339. Epub 2012 Dec 18.

Antiepileptic drugs during pregnancy in primary care: a UK population based study

Shuk-Li Man  1 , Irene Petersen, Mary Thompson, Irwin Nazareth
Affiliations

Antiepileptic drugs during pregnancy in primary care: a UK population based study

Shuk-Li Man et al. PLoS One. 2012.

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.

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Conflict of interest statement

Competing Interests: Dr. Shuk-Li Man's PhD is largely funded by the Medical Research Council, UK, but the authors also receive commercial funding for this research from Cegedim Strategic Data Medical Research UK, and Dr. Mary Thompson is also employed by Cegedim Strategic Data Medical Research UK. The authors declare that this does not alter their adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Percentage of pregnancies where AEDs were prescribed.
Figure 2
Figure 2. Proportion of pregnant women with epilepsy continuing AEDs by AED.
Figure 3
Figure 3. Proportion of women continuing AEDs: pregnant vs. non-pregnant women with A. epilepsy B. bipolar disorder or depression.
See this image and copyright information in PMC

References

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