Document Detail


Influencing clinical practice regarding the use of antiepileptic medications during pregnancy: modeling the potential impact on the prevalences of spina bifida and cleft palate in the United States.
MedLine Citation:
PMID:  21766433     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Selected antiepileptic drugs (AEDs) increase the risk of birth defects. To assess the impact of influencing AED prescribing practices on spina bifida and cleft palate we searched the literature for estimates of the association between valproic acid or carbamazepine use during pregnancy and these defects and summarized the associations using meta-analyses. We estimated distributions of the prevalence of valproic acid and carbamazepine use among women of childbearing age based on analyses of four data sets. We estimated the attributable fractions and the number of children born with each defect that could be prevented annually in the United States if valproic acid and carbamazepine were not used during pregnancy. The summary odds ratio estimate for the association between valproic acid and spina bifida was 11.9 (95% uncertainty interval (UI): 4.0-21.2); for valproic acid and cleft palate 5.8 (95% UI: 3.3-9.5); for carbamazepine and spina bifida 3.6 (95% UI: 1.3-7.8); and for carbamazepine and cleft palate 2.4 (95% UI: 1.1-4.5) in the United States. Approximately 40 infants (95% UI: 10-100) with spina bifida and 35 infants (95% UI: 10-70) with cleft palate could be born without these defects each year if valproic acid were not used during pregnancy; 5 infants (95% UI: 0-15) with spina bifida and 5 infants (95% UI: 0-15) with cleft palate could be born without these defects each year if carbamazepine were not used during pregnancy. This modeling approach could be extended to other medications to estimate the impact of translating pharmacoepidemiologic data to evidence-based prenatal care practice.
Authors:
Suzanne M Gilboa; Cheryl S Broussard; Owen J Devine; Kara N Duwe; Audrey L Flak; Sheree L Boulet; Cynthia A Moore; Martha M Werler; Margaret A Honein
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Publication Detail:
Type:  Journal Article     Date:  2011-07-15
Journal Detail:
Title:  American journal of medical genetics. Part C, Seminars in medical genetics     Volume:  157C     ISSN:  1552-4876     ISO Abbreviation:  Am J Med Genet C Semin Med Genet     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-07-20     Completed Date:  2011-12-23     Revised Date:  2013-09-16    
Medline Journal Info:
Nlm Unique ID:  101235745     Medline TA:  Am J Med Genet C Semin Med Genet     Country:  United States    
Other Details:
Languages:  eng     Pagination:  234-46     Citation Subset:  IM    
Copyright Information:
Published 2011 Wiley-Liss, Inc.
Affiliation:
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA. sgilboa@cdc.gov
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MeSH Terms
Descriptor/Qualifier:
Anticonvulsants / adverse effects,  therapeutic use*
Carbamazepine / adverse effects,  therapeutic use
Cleft Palate / chemically induced,  epidemiology*,  prevention & control
Female
Humans
Pregnancy
Pregnancy Complications / drug therapy
Prenatal Care
Prevalence
Spinal Dysraphism / chemically induced,  epidemiology*,  prevention & control
United States
Valproic Acid / adverse effects,  therapeutic use
Chemical
Reg. No./Substance:
0/Anticonvulsants; 298-46-4/Carbamazepine; 99-66-1/Valproic Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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