The prescribing of antiepileptic drugs for pregnant Australian women
Article first published online: 12 SEP 2011
© 2011 The Authors. ANZJOG © 2011 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Australian and New Zealand Journal of Obstetrics and Gynaecology
Volume 52, Issue 1, pages 49–53, February 2012
How to Cite
VAJDA, F. J.E., HORGAN, D., HOLLINGWORTH, S., GRAHAM, J., HITCHCOCK, A. A., ROTEN, A., O’BRIEN, T. J., LANDER, C. M. and EADIE, M. J. (2012), The prescribing of antiepileptic drugs for pregnant Australian women. Australian and New Zealand Journal of Obstetrics and Gynaecology, 52: 49–53. doi: 10.1111/j.1479-828X.2011.01359.x
- Issue published online: 6 FEB 2012
- Article first published online: 12 SEP 2011
- Received 16 March 2011; accepted 24 July 2011.
- antiepileptic drugs;
- Australian Pregnancy Register;
- fetal malformation;
- referral patterns;
Background: It is not clear how widely it is appreciated in Australia that certain antiepileptic drugs, particularly valproate, are teratogenic.
Aim: The aim of the study is to assess trends in the pattern of antiepileptic drug prescribing for pregnant women in Australia to determine whether drug use is optimal, particularly from the fetal viewpoint.
Methods: Analysis of data contained in the Australian Register of Antiepileptic Drugs, assessing trends in antiepileptic drug use correlated with pregnancy outcomes.
Results: Valproate was the only significant teratogen among the antiepileptic drugs in common use. There was a fetal malformation rate of 14.5% associated with its use in monotherapy, as compared with a rate of 3.15% in antiepileptic drug-unexposed pregnancies in women with epilepsy (OR = 5.23, 95% CI = 1.81, 15.09). The highest malformation rate associated with any other antiepileptic drug used in monotherapy was 5.0%, for carbamazepine. Neurologists had progressively prescribed valproate less frequently and in lower dosage than other classes of practitioner over the 10-year study period, with a parallel decrease in occurrence of fetal malformations in pregnancies referred to the Register. Other prescribers of valproate did not seem to have adopted these practices to the same extent and had not obtained similar degrees of reduction in the occurrence of fetal malformations.
Conclusions: Contemporary Australian obstetricians, even though they may not be valproate prescribers, when managing pregnancies in women taking valproate, need to be alert to the possibility that it may not be being used optimally from the fetal point of view, especially when not prescribed by neurologists.