The prescribing of antiepileptic drugs for pregnant Australian women

Vajda, Frank J. E., Horgan, David, Hollingworth, Samantha, Graham, Janet, Hitchcock, Alison A., Roten, Annie, O’Brien, Terence J., Lander, Cecile M. and Eadie, Mervyn J. (2012) The prescribing of antiepileptic drugs for pregnant Australian women. The Australian and New Zealand Journal of Obstetrics and Gynaecology, 52 1: 49-53. doi:10.1111/j.1479-828X.2011.01359.x

Author Vajda, Frank J. E.
Horgan, David
Hollingworth, Samantha
Graham, Janet
Hitchcock, Alison A.
Roten, Annie
O’Brien, Terence J.
Lander, Cecile M.
Eadie, Mervyn J.
Title The prescribing of antiepileptic drugs for pregnant Australian women
Journal name The Australian and New Zealand Journal of Obstetrics and Gynaecology   Check publisher's open access policy
ISSN 0004-8666
Publication date 2012-02
Year available 2011
Sub-type Article (original research)
DOI 10.1111/j.1479-828X.2011.01359.x
Volume 52
Issue 1
Start page 49
End page 53
Total pages 5
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2012
Language eng
Formatted abstract
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.

  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.
Keyword Antiepileptic drugs
Australian Pregnancy Register
Fetal malformation
Referral patterns
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article first published online: 12 SEP 2011

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Public Health Publications
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 12 times in Thomson Reuters Web of Science Article | Citations
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Created: Fri, 14 Oct 2011, 15:59:32 EST by Geraldine Fitzgerald on behalf of School of Public Health