AUTHOR=Shouman Walid , Delaney Joseph A. , Kowalec Kaarina , Ng Marcus , Ruth Chelsea , Falk Jamieson , Leong Christine , Alessi-Severini Silvia , Lavu Alekhya , Peymani Payam , Eltonsy Sherif 

TITLE=Trends of Utilization of Antiseizure Medications Among Pregnant Women in Manitoba, Canada: A 20-Year Population-Based Study

JOURNAL=Frontiers in Pharmacology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.871136

DOI=10.3389/fphar.2022.871136

ISSN=1663-9812

ABSTRACT=Background: Evidence from developed countries demonstrates that the use of anti-epileptic drugs (AEDs) has been increasing in the last decade. Pregnant women have a very challenging risk benefit trade-off in terms of AED utilization, and it is crucial to know if increased utilization is seen among pregnant women.
Objective: To examine time-trends of utilization of AED therapies among pregnant women in Manitoba, Canada. 
Methods: We conducted a population-based cohort study using de-identified, linked administrative databases from Manitoba. Pregnancies between 1995 and 2018 were included. Four groups of pregnant people were created based on AED exposure and epilepsy diagnosis. 
Results: Of 273,492 pregnancies, 812 (3/1000) had an epilepsy diagnosis and were exposed to AEDs, 963 (3.5/1000) had an epilepsy diagnosis and were unexposed, and 2742 (10/1000) were exposed to AEDs and did not have epilepsy diagnosis. Overall, the number of pregnancies exposed to AEDs increased significantly from 0.56% in 1997 to 2.21% in 2018 (p<0.0001). Subgroup analysis by epilepsy diagnosis showed no significant change in AEDs exposure among women with epilepsy (0.37% [1997] to 0.36% [2018], p=0.24). A drop in carbamazepine use was observed, while the number of lamotrigine prescriptions increased from 6.45% in 1997 to 52%  by 2018. AEDs use among pregnant women without epilepsy increased significantly from 0.19% in 1997 to 1.85% in 2018 (p<0.0001). In the total cohort of pregnancies, 1439 (0.53%) were exposed during their entire pregnancy, and 1369 (0.5%) were exposed in the first trimester. Clonazepam was the most used AED during the study period (1953 users, 0.71%), followed by gabapentin (785 users, 0.29%) and carbamazepine (449 users, 0.16%). 
Conclusion: No major shifts in the quantity of AEDs use over the study period were observed among pregnant women with epilepsy. However, there was a significant increase in AEDs use among pregnant women without epilepsy. The study results warrant further investigation into the implications of AEDs use in pregnancy for other indications than epilepsy.