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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.

Original publication

DOI

10.1186/s12884-021-04351-x

Type

Journal article

Journal

BMC Pregnancy Childbirth

Publication Date

27/01/2022

Volume

22

Keywords

Bipolar Disorder, Computerised, Contraception, Epilepsy, General practice, High-Risk, Medical record systems, Migraine Disorders, Pregnancy, Prenatal Care, Valproic Acid, Adolescent, Adult, Anticonvulsants, Antimanic Agents, Bipolar Disorder, Cohort Studies, Contraception, Cross-Sectional Studies, Drug Prescriptions, Epilepsy, Female, General Practitioners, Humans, Middle Aged, Migraine Disorders, Practice Patterns, Physicians', Pregnancy, Pregnancy Complications, Primary Health Care, Retrospective Studies, United Kingdom, Valproic Acid, Young Adult