Teratogenic risk and contraceptive counselling in psychiatric practice: analysis of anticonvulsant therapy

BMC Psychiatry

Maria Oto²  Andrea Perry³  Julie Langan¹ 

[1] Institute of Health and Wellbeing, University of Glasgow, Mental Health and Wellbeing, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK;ST6 General Adult Psychiatry, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK;ST6 General Adult Psychiatry NHSGG&C, Esteem Service, 60 Mollinsburn Street, Glasgow G21 4SF, UK

关键词: Contraception;    Teratogenic potential;    Child bearing age;    Women;    Topiramate;    Lamotrigine;    Carbamazepine;    Valproate;    Anticonvulsant;   

Others  :  1123959
DOI  :  10.1186/1471-244X-13-234

 received in 2013-02-11, accepted in 2013-09-23,  发布年份 2013

【 摘 要 】

Background

Anticonvulsants have been used to manage psychiatric conditions for over 50 years. It is recognised that some, particularly valproate, carbamazepine and lamotrigine, are human teratogens, while others including topiramate require further investigation. We aimed to appraise the documentation of this risk by psychiatrists and review discussion around contraceptive issues.

Methods

A retrospective review of prescribing patterns of four anticonvulsants (valproate, carbamazepine, lamotrigine and topiramate) in women of child bearing age was undertaken. Documented evidence of discussion surrounding teratogenicity and contraceptive issues was sought.

Results

Valproate was most commonly prescribed (n=67). Evidence of teratogenic risk counselling at medication initiation was sub-optimal – 40% of individuals prescribed carbamazepine and 22% of valproate. Documentation surrounding contraceptive issues was also low- 17% of individuals prescribed carbamazepine and 13% of valproate.

Conclusion

We found both low rates of teratogenic risk counselling and low rates of contraception advice in our cohort. Given the high rates of unplanned pregnancies combined with the relatively high risk of major congenital malformations, it is essential that a detailed appraisal of the risks and benefits associated with anticonvulsant medication occurs and is documented within patients’ psychiatric notes.

【 授权许可】

   
2013 Langan et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Lambert PA, Venaud G: Utilisation de valpromide en thérapeutique psychiatrique. L'encephale 1966, 8:367-373.
• [2]Okuma T, Kishimoto A, Inoue K, Matsumoto H, Ogura A: Anti-manic and prophylactic effects of carbamazepine (Tegretol) on manic depressive psychosis. A preliminary report. Folia Psychiatr Neurol Jpn 1973, 27:283-297. PubMed
• [3]SIGN Guideline 82. http://www.sign.ac.uk/guidelines/fulltext/82/index.html webcite
• [4]Perrucs E: Birth defects after prenatal exposure to anti epileptic drugs. Lancet Neurol 2005, 4:781-786.
• [5]Fried S, Kozer E, Nulman I, Einarson TR, Koren G: Malformation rates in children of women with untreated epilepsy: a meta-analysis. Drug Saf 2004, 27:197-202.
• [6]Samrén EB, van Duijn CM, Koch S, Hiilesmaa VK, Klepel H, Bardy AH, Mannagetta GB, Deichl AW, Gaily E, Granström ML, Meinardi H, Grobbee DE, Hofman A, Janz D, Lindhout D: Maternal use of anti-epileptic drugs and risk of major congenital malformations; a joint European prospective study of human teratoegnesis. Epilepsia 1997, 38:981-990.
• [7]Tomson T, Battino D, Bonizzoni E, Craig J, Lindhout D, Sabers A, Perucca E, Vajda F, for the EURAP Study Group: Dose dependent risk of malformation with anti-epileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry. Lancet 2001, 10(7):609-617.
• [8]Adab N, Kini U, Vinten J, Ayres J, Baker G, Clayton-Smith J, Coyle H, Fryer A, Gorry J, Gregg J, Mawer G, Nicolaides P, Pickering L, Tunnicliffe L, Chadwick DW: The longer term outcome of children born to mothers with epilepsy. J Neurol Neurosurg Psychiatry 2004, 75:1575-1583.
• [9]Matalon S, Schechtman S, Goldzweig G, Ornoy A: The teratogenic effects of carbamazepine; a meta-analysis of 1255 exposures. Reprod Toxicol 2002, 16:9-17.
• [10]Diav-Citrin O, Shechtman S, Arnon J, Ornoy A: Is carbamazepine teratogenic? a prospective controlled study of 210 pregnancies. Neurology 2001, 24; 57(2):321-324.
• [11]Hiilesmaa VK, Teramo K, Granström ML, Bardy AH: Fetal head growth retardation associated with maternal antiepileptic drugs. Lancet 1981, 25;2(8239):165-167.
• [12]Vajda FJE, Graham J, Roten A, Lander CM, O’Brien TJ, Eadie M: Teratogenicity of the newer antiepileptic drugs – the Australian experience. J Clin Neurosci 2012, 19(1):57-59. doi:10.1016/j.jocn.2011.08.003
• [13]Citrome L: Adjunctive lithium and anticonvulsants for the treatment of schizophrenia: what is the evidence? Expert Rev Neurother 2009, 9:1:55-71.
• [14]Leucht S, Kissling W, McGrath J, White P: Carbamazepine for schizophrenia. Cochrane Database Syst Rev 2007., (3) DOI: 10.1002/14651858.CD001258
• [15]Basan A, Kissling W, Leucht S: Valproate as an adjunct to antipsychotics for schizophrenia: a systematic review of randomized trials. Schizophr Res 2004, 70:33-37. PubMed
• [16]Grunze H: The effectiveness of anticonvulsants in psychiatric disorders. Dialogues Clin Neurosci 2008, 10(1):77-89.
• [17]James L, Barnes TR, Lelliott P, Taylor D, Paton C: Informing patients of the teratogenic potential of mood stabilising drugs: a case note review of the practice of psychiatrists. J Psychopharmacol 2007, 21:815.
• [18]BNF: 4.8.1 Control of the Epilepsies. British National Formulary September 2013 4.8.1 Control of the Epilepsies
• [19]Wieck A, Rao S, Sein K, Haddad PM: A survey of antiepileptic prescribing to women of child bearing potential in psychiatry. Arch Womens Ment Health 2007, 10:83-85.
• [20]Taylor D, Paton C, Kapur S: The Maudsley Prescribing Guidelines. 10th edition. Infroma Healthcare; 2009:126.
• [21]Heffner JL, DelBello MP, Fleck DE, Adler CM, Strakowski SM: Unplanned pregnancies in adolescents with bipolar disorder. Am J Psychiatry 2012, 169:1319-1319.
• [22]Scotland's Population: The Registrar General’s Annual Review of Demographic Trends. 157th edition. 2011. http://www.gro-scotland.gov.uk/files2/stats/annual-review-2011/j21285204.htm#fg22 webcite
• [23]World Health Organisation: Guidelines for ATC classification and DDD assignment. Geneva: WHO; 2013.