(88) Dynamic Pattern of Anti-Epileptic Drug During Pregnancy Among Women with Epilepsy by Using Linking Database in Taiwan

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1133

Presenting Author(s)

Ju-Ling Chen
– National Cheng Kung University, Tainan City , Taiwan

Co-Author(s)

Yea-Huei Kao Yang, RPh, FISPE
– Professor, NCKU Institute of Clinical Pharmacy and Pharmaceutical Sciences, Tainan, Taiwan (Republic of China)
Ching-Lan Cheng
– School of Pharmacy and, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan (Republic of China)

Background: Most studies indicated that birth rates in women with epilepsy (WWE) were lower than other groups and the modification of anti-epileptic drugs (AEDs) during pregnancy was also recommended. However, there are few reports about AEDs switching pattern between pre-conception and different trimesters.

Objectives: This study aim was to evaluate the dynamic AEDs exposure pattern before and during pregnancy in women with epilepsy (WWE) by using linking database in Taiwan.

Methods: We selected a cohort of women who aged from 15 to 55 yrs and ever diagnosed with epilepsy in 2009 to 2018. Pregnancy women with prenatal visit records were identified and the last menstrual period (LMP) was evaluated through linked data from Birth Certificate Database and Maternal and Child Health Database (MCHD), where were records of women with gestational week more than 20 weeks including still birth. The definition of pregnant women with active epilepsy was who at least two outpatient visits for epilepsy or at least one hospitalization of epilepsy within two years prior to conception. We performed Sankey diagrams to present the changes of AEDs utilization in pregnancy over time. IF mother with gestational age less than 24 weeks were excluded from the analysis for lacking of 3rd trimester. AEDs were classified to 1st and 2nd generation according to the time to market. Patient who exposed to both 1st and 2nd generation were classified as 2nd generation users and who exposed to at least two AEDs with different mechanism were classified as polytherapy.

Results: Around 7.4% (6,441/86,519) WWE achieved pregnant and 89% (5,712/6,441) have birth record. In the linked database, 93% of mothers’ LMP date could be established. 2,027 WWE with active epilepsy were considered to be continuing their pharmacotherapy during pregnancy and 2,021 subjects were included for analyzing. 42% of pregnant WWE didn’t receive AEDs therapy before conception, and the proportion of un-exposure ones were increased accompanied with trimesters and decreased after delivery. In Sankey diagram, we found that 80% of exposure WWE didn’t change the AED type and 50% to 70% un-exposed subjects changed to use 2nd generation AEDs when needed. Prescribing rate of 1st generation was decreased from 18% to 11%. For polytherapy users, the prescribing rate was declined from 34% to 27% during pregnancy and back to 31% after deliveries.

Conclusions: The dynamic pattern of AEDs in Taiwan was similar with Western countries. The outcome of maternal or neonatal still need to investigate in further study.