Treatment decisions in women of childbearing age on valproate

Abstract

Introduction There are little data on the understanding and participation of women of childbearing age in decisions about their choice of antiepileptic drugs (AEDs). Valproate carries a risk of major congenital malformations, developmental and behavioural delay. For some, valproate is the only medication to prevent potentially life‐threatening seizures. Materials & Methods This was a cross‐sectional study of two groups of women of childbearing age; 50 taking valproate and 50 controls. Each patient completed a patient questionnaire and structured telephone interview assessing understanding of the risks and benefits of AEDs in relation to pregnancy. Analysis used unpaired two‐tailed t test and chi‐squared test, with Bonferroni correction. Follow‐up at 12 months showed that 8% of the women taking valproate had switched to other medication. Results Hundred patients participated in the study, 89 on AEDs for epilepsy, 4 for migraine, and 7 for both. 55% of participants stated they were not involved in decision‐making. More patients in the valproate group were informed about (64% vs 42%, P < .005), and expressed understanding of (64%vs 32%, P < .001), the risks involved with treatment. 59% of all patients wanted more information. The minority of women surveyed took folic acid (37%) or used contraceptives (29%). Valproate was used following failure of other AEDs to control seizures in 80%. Discussion This in‐depth survey suggests more information is needed for women taking AEDs, using a range of formats. Women taking valproate are better informed than those on levetiracetam or lamotrigine. Information provision on the use of folic acid and contraception needs improvement.

Twenty-year trends in the use of anti-seizure medication among pregnant women in the Netherlands

“…Switching to lamotrigine can be limited by the required slow titration due to risk of Stevens-Johnson Syndrome [35], and switching to levetiracetam can be limited by mood side effects [36]. Outcome research can guide targeted preventive interventions and education programs, and specific recommendations can be made for each ASM [14,37]. There seems to be more need to educate certain groups such as GPs who prescribed the majority of ASMs.…”

Compliance with Prescribing and Dispensing Conditions for Valproate and Related Substances in Girls and Women of Childbearing Potential: A Survey of Community Pharmacists in France

“…Similarly, the 2020 survey results showed the level of compliance returning to the levels found in 2017 (compliance rate: 47%). In the UK, a survey conducted in 2017, 2 years after initial measures were introduced, revealed that 64% of women of childbearing potential treated with valproate reported that they had been informed and understood the risks associated with their treatment [21]. The analysis of the French National Health Insurance Database from 2011 to 2017 considering 114,936 female patients with epilepsy aged under 50 years found that prevalent use of valproate among girls and women of childbearing potential with epilepsy had decreased significantly after the implementation of RMMs, after the first referral in 2015.…”

Are female bipolar patients of reproductive age aware of the teratogenic risk of sodium valproate? A qualitative study

“…Sodium valproate use in pregnancy is not recommended and appropriate prescribing should be practised in this patient group. 22,26,27…”