Trends in Valproate Prescriptions for Non-Epilepsy Indications among Women Aged 15 - 44 Years U.S. 1996 - 2007: [A Population-Based Study] 公开
Adedinsewo, Demilade Adenike (2012)
Published
Abstract
Background: Scientific evidence has consistently shown
taking valproate (VPA) during
pregnancy increases the risk of neural tube defects. This study was
conducted to estimate
the prevalence and trends in VPA prescriptions for non-epilepsy
indications among U.S.
women of childbearing age.
Methods: We obtained data on individual prescriptions for
women aged 15 - 44 years
from the National Ambulatory Medical Care Survey (NAMCS) and the
National Hospital
Ambulatory Medical Care Survey (NHAMCS) from 1996-2007. Women were
classified
as having epilepsy/seizure (WWE) or not (WWNE) using ICD-9-CM
diagnostic codes.
Using sampled case specific weights and variances; we estimated the
number of anti-
epileptic drug (AED) prescriptions, VPA prescriptions, patient
visits, and the prevalence
of AED and VPA prescriptions to women with no epilepsy or
seizure.
Results: Eighty-eight percent of all AED prescriptions and
83% of all VPA prescriptions
were for non-epilepsy/non-seizure indications. The prevalence of
all AED prescriptions
among WWNE more than tripled between 1996 and 2007 (10.3 vs. 34.9
per 1000 patient
visits), while the prevalence of VPA prescriptions in this group
remained stable over
time- 3.1 per 1000 patient visits (95% CI: 2.3 - 3.9) in 1996-1998
vs. 3.7 per 1000 patient
visits (95% CI: 2.8 - 4.7) in 2005-2007. Eight-three percent of all
VPA prescriptions were
to WWNE-- most for psychiatric indications
Conclusion: Our data showed that between 1996 and 2007, in
the United States, the use
of the teratogen--VPA did not decline among women of childbearing
age who did not
have a diagnosis of epilepsy or seizure. Thus far, prevention
guidelines have been
developed for WWE while little attention has been given to women
with psychiatric
disorders who may be prescribed VPA. The results of this study
suggest the need for
guidelines to either avoid or reduce significantly the use of VPA
among women of
childbearing potential who do not have epilepsy or seizure
disorders. Interventions to
prevent birth defects associated with VPA use during pregnancy are
urgently needed and
should be targeted towards women receiving VPA for psychiatric
indications as well as
toward women with epilepsy and seizure disorders.
Table of Contents
TABLE OF CONTENTS
BACKGROUND.. 1
ABSTRACT. 6
INTRODUCTION.. 7
METHODS. 9
RESULTS. 12
DISCUSSION / CONCLUSION.. 14
REFERENCES. 17
TABLES. 22
Table 1. Prevalence and Number of AED and valproate prescriptions for U.S women without a diagnosis of Epilepsy/Seizure (WWNE) aged 15-44 years from 1996 - 2007 22
FIGURES. 23
Figure 1. Prevalence (per 1,000 patient visits) of valproate prescriptions for U.S women without a diagnosis of Epilepsy/Seizure (WWNE) aged 15-44 years from 1996-2007. 23
Figure 2. Valproate prescriptions made to all U.S. women aged 15 - 44 years by diagnosis category from 1996-2007. (Overall 'N'=10,648,000 prescriptions over a 12 year period) 24
Figure 3. Valproate prescriptions made to U.S. women aged 15 - 44 years without a diagnosis of Epilepsy/Seizure (WWNE) by indication from 1996-2007 (n = 8,818,000 prescriptions over a 12 year period) 25
SUMMARY, PUBLIC HEALTH IMPLICATIONS, POSSIBLE FUTURE DIRECTIONS. 26
APPENDICES. 28
Table 2. Number (Frequency) of AED and VPA Prescriptions - Estimated in ten thousands, made to women aged 15 - 44 years, 1996 - 2007 28
Table 3. Prevalence of AED and VPA Prescriptions (per 1,000 patient visits) among women aged 15 - 44 years, 1996 - 2007 29
Figure 4. Trends in the proportion of VPA prescriptions for Psychiatric disorders from 1996-2007 30
Figure 5. Trends in the proportion of VPA prescriptions for pain and other non-epilepsy disorders from 1996-2007 31
Figure 6. Distribution of specific AED prescriptions by diagnosis category made to all U.S women aged 15 - 44 years from 1996-2007 32
Figure 7 Distribution and trends in AED prescriptions for Psychiatric disorders from 1996-2007. 32
Figure 8. Distribution and trends in AED prescriptions for Pain disorders from 1996-2007. 33
Figure 9. Distribution and trends in AED prescriptions for Migraine from 1996-2007. 33
Table 4. Codes used for Anti-epileptic Drugs 34
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