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Valproate prescription to women of childbearing age in English primary care: repeated cross-sectional analyses and retrospective cohort study
BACKGROUND: Valproate is a teratogenic drug that should be avoided during the preconception period and pregnancy. The aim was to explore general practitioners’ (GPs) prescription patterns over time, describe trends, and explore inter-practice variation within primary care. METHODS: We identified wom...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8793222/ https://www.ncbi.nlm.nih.gov/pubmed/35086478 http://dx.doi.org/10.1186/s12884-021-04351-x |
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author | Gaudio, Mariangela Konstantara, Emmanouela Joy, Mark van Vlymen, Jeremy de Lusignan, Simon |
author_facet | Gaudio, Mariangela Konstantara, Emmanouela Joy, Mark van Vlymen, Jeremy de Lusignan, Simon |
author_sort | Gaudio, Mariangela |
collection | PubMed |
description | BACKGROUND: Valproate is a teratogenic drug that should be avoided during the preconception period and pregnancy. The aim was to explore general practitioners’ (GPs) prescription patterns over time, describe trends, and explore inter-practice variation within primary care. METHODS: We identified women of childbearing age (12–46 years old) in the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network. We performed repeated cross-sectional analyses from 2004 to 2018 to determine rates of prescription and a retrospective cohort estimated the prevalence of use of valproate during pregnancy. RESULTS: In 2004, 0.31% (95% Confidence Interval (95%CI):0.18 to 0.44%) women were prescribed valproate, decreasing to 0.16% (95%CI:0.07 to 0.24%) by 2018. Among women with epilepsy, the rate fell from 15.2% (95%CI:14.4 to 16.0%) to 8.8% (95% CI:8.2 to 9.7%) over the same period. In 2018, almost two thirds (62.2%) of women who were prescribed valproate had epilepsy only, whereas bipolar disorder and migraine accounted for 15.8% and 7.4% respectively. Contraceptive prescriptions did not increase over time, and only in 2018 was there greater odds of being prescribed contraception (OR 1.41, 95%CI:1.08 to 1.45). Just under a fifth (19.7%) of women were prescribed valproate during their pregnancy; two out of three of these pregnancies were preceded by folic acid prescription (5 mg). While some practices reduced their rate of valproate prescription, others did not. CONCLUSIONS: Regulatory guidelines have changed GPs' prescription patterns in women of childbearing potential for valproate but not for contraception. Further research is needed to identify the barriers of GPs and women of childbearing potential to undertaking contraception. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-021-04351-x. |
format | Online Article Text |
id | pubmed-8793222 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-87932222022-02-03 Valproate prescription to women of childbearing age in English primary care: repeated cross-sectional analyses and retrospective cohort study Gaudio, Mariangela Konstantara, Emmanouela Joy, Mark van Vlymen, Jeremy de Lusignan, Simon BMC Pregnancy Childbirth Research Article BACKGROUND: Valproate is a teratogenic drug that should be avoided during the preconception period and pregnancy. The aim was to explore general practitioners’ (GPs) prescription patterns over time, describe trends, and explore inter-practice variation within primary care. METHODS: We identified women of childbearing age (12–46 years old) in the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network. We performed repeated cross-sectional analyses from 2004 to 2018 to determine rates of prescription and a retrospective cohort estimated the prevalence of use of valproate during pregnancy. RESULTS: In 2004, 0.31% (95% Confidence Interval (95%CI):0.18 to 0.44%) women were prescribed valproate, decreasing to 0.16% (95%CI:0.07 to 0.24%) by 2018. Among women with epilepsy, the rate fell from 15.2% (95%CI:14.4 to 16.0%) to 8.8% (95% CI:8.2 to 9.7%) over the same period. In 2018, almost two thirds (62.2%) of women who were prescribed valproate had epilepsy only, whereas bipolar disorder and migraine accounted for 15.8% and 7.4% respectively. Contraceptive prescriptions did not increase over time, and only in 2018 was there greater odds of being prescribed contraception (OR 1.41, 95%CI:1.08 to 1.45). Just under a fifth (19.7%) of women were prescribed valproate during their pregnancy; two out of three of these pregnancies were preceded by folic acid prescription (5 mg). While some practices reduced their rate of valproate prescription, others did not. CONCLUSIONS: Regulatory guidelines have changed GPs' prescription patterns in women of childbearing potential for valproate but not for contraception. Further research is needed to identify the barriers of GPs and women of childbearing potential to undertaking contraception. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-021-04351-x. BioMed Central 2022-01-27 /pmc/articles/PMC8793222/ /pubmed/35086478 http://dx.doi.org/10.1186/s12884-021-04351-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Gaudio, Mariangela Konstantara, Emmanouela Joy, Mark van Vlymen, Jeremy de Lusignan, Simon Valproate prescription to women of childbearing age in English primary care: repeated cross-sectional analyses and retrospective cohort study |
title | Valproate prescription to women of childbearing age in English primary care: repeated cross-sectional analyses and retrospective cohort study |
title_full | Valproate prescription to women of childbearing age in English primary care: repeated cross-sectional analyses and retrospective cohort study |
title_fullStr | Valproate prescription to women of childbearing age in English primary care: repeated cross-sectional analyses and retrospective cohort study |
title_full_unstemmed | Valproate prescription to women of childbearing age in English primary care: repeated cross-sectional analyses and retrospective cohort study |
title_short | Valproate prescription to women of childbearing age in English primary care: repeated cross-sectional analyses and retrospective cohort study |
title_sort | valproate prescription to women of childbearing age in english primary care: repeated cross-sectional analyses and retrospective cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8793222/ https://www.ncbi.nlm.nih.gov/pubmed/35086478 http://dx.doi.org/10.1186/s12884-021-04351-x |
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