Prescribing trends of antiepileptic drugs (AED) and mood stabilizers (MS) among pregnant women between 2011 and 2017 in France. Study from the French national health insurance database (SNDS).
Abstract number :
101
Submission category :
4. Clinical Epilepsy / 4E. Women's Issues
Year :
2020
Submission ID :
2422449
Source :
www.aesnet.org
Presentation date :
12/5/2020 9:07:12 AM
Published date :
Nov 21, 2020, 02:24 AM
Authors :
Arnaud Biraben, CHU Rennes; Adeline Degremont - CHU Rennes; Sandrine Kerbrat - CHU Rennes; helene Tillaut - EHESP; emmanuelle Leray - EHESP; Emmanuel Oger - Université Rennes 1; Elisabeth Polard - CHU Rennes; Frederic Balusson - CHU Rennes;
Rationale:
Since 2009 we have the proof that valproate (VPA) is teratogenic. American Academy of Neurology, then European Medicine Agency and French authorities launched risk minimization recommendations (RMR) regarding the VPA prescription in women of child bearing age. What are the impacts of these RMR at the nation level?
Method:
We used the SNDS data to describe the prescribing trends of AED and MS among women who had a pregnancy between Jan 2013 and March 2017. We focused on women who received at least one claiù of VPA up to two years before pregnancy (2011). We analyzed the proportion of women who was treated with VPA over the pregnancy period, focusing the evolution before, during and after pregnancy between 2013 and 2016. We distinguished the population with epilepsy and the one with mood disorders (MD). Results 14,794 pregnancies were analyzed over the study period. Among these pregnancies, 4673 were epileptic and 8083 had MD. The proportion of epileptic women exposed to VPA during pregnancy decreased from 26.4% in 2013 to 9.3% in 2016, mainly in favor of lamotrigine and levetiracetam. The proportion of women exposed to VPA before pregnancy also decreased, however 50.9% of those women were still exposed during the first trimester of pregnancy in 2016. Less than 10% consulted a specialist before pregnancy
The proportion of MD women exposed to VPA decreased during pregnancy from 3.7% in 2013 to 1.9% in 2016 mainly in favor of no treatment. It also decreased before pregnancy, from 31.3% in 2013 to 15.9% in 2016, however 38.6% of those women were still exposed in the first trimester of pregnancy in 2016. Among this population less than one third consulted a specialist before pregnancy.
Conclusion:
We can notice that prior the RMR there is a trend to reduce the VPA prescription in woman of child bearing age. This trend increased after RMR, especially before pregnancy. However, exposure levels during the first trimester of pregnancy remain high. These results suggest that i/ that RMR need to be strengthened to support pregnancy planning; ii/that the RMR do not reach the whole target; iii/ that VPA is the only effective medication for a small amount of epileptic syndrome. In such cases it is difficult to make a choice between the risk of teratogenicity and the risk of seizure.
Funding:
:LFCE : Ligue Française contre l'épilepsie
Clinical Epilepsy