dc.contributor.author	Kinney, Michael O.
dc.contributor.author	Morrow, James
dc.contributor.author	Patterson, Chris C.
dc.contributor.author	Campbell, Ellen
dc.contributor.author	Russell, Aline
dc.contributor.author	Smithson, W. Henry
dc.contributor.author	Parsons, Linda
dc.contributor.author	Morrison, Patrick J.
dc.contributor.author	Bromley, Rebecca
dc.contributor.author	Liggan, Brenda
dc.contributor.author	Delanty, Norman
dc.contributor.author	Irwin, Beth
dc.contributor.author	Hunt, Stephen J.
dc.contributor.author	Craig, John J.
dc.date.accessioned	2018-07-03T08:50:11Z
dc.date.available	2018-07-03T08:50:11Z
dc.date.issued	2018-04-16
dc.date.updated	2018-07-03T08:31:06Z
dc.description.abstract	Objectives: After 20 years of data collection, pregnancy registers have informed prescribing practice. Various populations show trends for a reduction in valproate prescribing, which is associated with an increased risk of anatomical teratogenesis and neurodevelopmental effects in those exposed in utero. Our aim was to determine if any shifts in prescribing trends have occurred in the UK and Ireland Epilepsy and Pregnancy Register cohort and to assess if there had been any change in the overall major congenital malformation (MCM) rate over time. Methods: The UK and Ireland Epilepsy and Pregnancy Register, a prospective, observational, registration and follow-up study established in 1996, was used to determine the changes in antiepileptic drugs (AEDs) utilised during pregnancy and the MCM rate between 1996 and 2016. Linear regression analysis was used to assess changes in AED utilisation, and Poisson regression was used for the analysis of trends in the MCM rates. Results: Outcome data for 9247 pregnancies showed a stable percentage of monotherapy to polytherapy prescribing habits over time. After Bonferroni correction, statistically significant (p<0.003) changes were found in monotherapy prescribing with increases in lamotrigine and levetiracetam and decreases in valproate and carbamazepine use. Between 1996 and 2016, the total MCM rate showed a 2.1% reduction per year (incidence risk ratio 0.979 (95% CIs 0.956 to 1.002) but Poisson regression analysis showed that this was not statistically significant p=0.08). Conclusion: Significant changes are seen in the prescribing habits in this cohort over 20 years, but a statistically significant change in the MCM rate was not detected. This work should be replicated on a larger scale to determine if significant changes are occurring in the MCM rate, which would allow a robust economic estimate of the benefits of improvements in prescribing practice and the personal effect of such changes.	en
dc.description.status	Peer reviewed	en
dc.description.version	Accepted Version	en
dc.format.mimetype	application/pdf	en
dc.identifier.citation	Kinney, M. O., Morrow, J., Patterson, C.C., Campbell, E., Russell, A., Smithson, W. H., Parsons, L., Morrison, P. J., Bromley, R., Liggan, B., Delanty, N., Irwin, B., Hunt, S. J. and Craig, J. J. (2018) 'Changing antiepilepsy drug-prescribing trends in women with epilepsy in the UK and Ireland and the impact on major congenital malformations', Journal of Neurology, Neuroscience and Psychiatry. doi:10.1136/jnnp-2017-317368	en
dc.identifier.doi	10.1136/jnnp-2017-317368
dc.identifier.issn	0022-3050
dc.identifier.journaltitle	Journal of Neurology, Neuroscience and Psychiatry	en
dc.identifier.uri	https://hdl.handle.net/10468/6404
dc.language.iso	en	en
dc.publisher	BMJ Publishing Group Ltd	en
dc.rights	© 2018, Article authors (or their employer(s) unless otherwise stated in the text of the article). This article has been accepted for publication in Journal of Neurology, Neuroscience and Psychiatry, 2018, following peer review, and the Version of Record can be accessed online at https://dx.doi.org/ 10.1136/jnnp-2017-317368. Reuse of this manuscript version is permitted strictly pursuant to the terms of the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/	en
dc.rights.uri	https://creativecommons.org/licenses/by-nc-nd/4.0/	en
dc.subject	Major congenital malformation	en
dc.subject	Valproate prescribing	en
dc.subject	In utero	en
dc.subject	AED	en
dc.subject	Anatomical teratogenesis	en
dc.subject	Neurodevelopmental effects	en
dc.title	Changing antiepilepsy drug-prescribing trends in women with epilepsy in the UK and Ireland and the impact on major congenital malformations	en
dc.type	Article (peer-reviewed)	en

Changing antiepilepsy drug-prescribing trends in women with epilepsy in the UK and Ireland and the impact on major congenital malformations

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