Real‐World Assessment of Psychotropic and Antiepileptic Drug Use During Pregnancy in Belgium: Trends, Predictors, and Comparative Risk of Congenital Anomalies (2010–2016)

• Published in: Pharmacoepidemiology and drug safety Vol. 33; no. 10; pp. e70021 - n/a
• Main Authors: Larcin, Lionel, Ngwasiri, Calypse, Neven, Anouk, Damase‐Michel, Christine, Kirakoya‐Samadoulougou, Fati
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Inc 01-10-2024; Wiley Subscription Services, Inc
• Subjects: Abnormalities, Drug-Induced - epidemiology; administrative healthcare database; Adolescent; Adult; Anticonvulsants - adverse effects; Antidepressants; Antidepressive Agents - adverse effects; Antiepileptic agents; antiepileptics; Antipsychotic Agents - adverse effects; Antipsychotics; Belgium - epidemiology; congenital anomalies; Congenital defects; Databases, Factual; Drug use; Etiracetam; Female; Fetuses; Humans; Lamotrigine; Pregnancy; Pregnancy Complications - drug therapy; Pregnancy Complications - epidemiology; Prevalence; Psychotropic drugs; Psychotropic Drugs - adverse effects; psychotropics; Regression analysis; Risk Factors; Sociodemographic Factors; Sociodemographics; valproate; Valproic acid; Young Adult; Belgium; valproate; antiepileptics; congenital anomalies; psychotropics; administrative healthcare database; pregnancy
• ISSN: 1053-8569; 1099-1557; 1099-1557
• DOI: 10.1002/pds.70021

ABSTRACT
Purpose
To analyze the prescription patterns and sociodemographic factors associated with the use of antipsychotic, antidepressant, and antiepileptic drugs during pregnancy in Belgium, and to investigate their potential association with congenital anomalies.
Methods
Using a nationwide linked database, we identified antidepressants, antipsychotics, and antiepileptics via the Anatomical Therapeutic and Chemical Classification (ATC) codes. For each medication group, we calculated the overall prevalence and prevalence for the three most used medications at the fifth ATC level. Sociodemographic factors influencing medication use during pregnancy were analyzed, and potential associations with congenital anomalies were investigated through logistic regression models based on generalized estimating equations.
Results
Overall, 828 016 live births pregnancies associated with 611 094 mothers were identified. We found that the use of antidepressants, antipsychotics, and antiepileptics was decreasing with the arrival of pregnancy. Mothers with a less favorable sociodemographic status were more likely to be exposed to these medications. Antiepileptics used in the first trimester were associated with an increased risk of congenital anomalies (aOR = 1.65, 95% CI 1.11–2.45) compared with unexposed women. The three most used antiepileptics were lamotrigine, valproate, and levetiracetam, among them, we found an association with congenital anomalies only for valproate (aOR = 3.92, 95% CI 2.30–6.67).
Conclusions
Psychotropic and antiepileptic drug use decreased during pregnancy. Pregnant women with a less favorable sociodemographic status were more likely to be exposed to psychotropics and antiepileptics during pregnancy. The elevated risk of congenital anomalies associated with antiepileptics use, particularly valproate, underscores the need for targeted interventions and increased awareness to improve maternal and fetal health outcomes.