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Use of sodium valproate and other antiseizure drug treatments in England and Wales: quantitative analysis of nationwide linked electronic health records

Caroline E Dale Orcid Logo, Rohan Takhar, Yat Yi Fan, Fatemeh Torabi Orcid Logo, Michail Katsoulis, Samuel Kim, Andrew Lambarth, Christopher Tomlinson Orcid Logo, Tim Wilkinson Orcid Logo, Tanja Mueller Orcid Logo, Amanj Kurdi Orcid Logo, Mark Ashworth, Mamas A Mamas, Kamlesh Khunti, Ashley Akbari Orcid Logo, Andrew D Morris, Munir Pirmohamed Orcid Logo, Anthony G Marson, David Williams Orcid Logo, David Hunt, Cathie Sudlow Orcid Logo, Reecha Sofat

BMJ Medicine, Volume: 3, Issue: 1, Start page: e000760

Swansea University Authors: Fatemeh Torabi Orcid Logo, Ashley Akbari Orcid Logo

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DOI (Published version): 10.1136/bmjmed-2023-000760

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Objective To investigate the use of sodium valproate in England and Wales, including during pregnancy, compared with other antiseizure drug treatments, based on national level electronic health records.Design Quantitative analysis of nationwide linked electronic health records.Setting Individual lev...

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Published in: BMJ Medicine
ISSN: 2754-0413
Published: BMJ 2024
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2025-01-23T16:10:48.5780791</datestamp><bib-version>v2</bib-version><id>68622</id><entry>2024-12-27</entry><title>Use of sodium valproate and other antiseizure drug treatments in England and Wales: quantitative analysis of nationwide linked electronic health records</title><swanseaauthors><author><sid>f569591e1bfb0e405b8091f99fec45d3</sid><ORCID>0000-0002-5853-4625</ORCID><firstname>Fatemeh</firstname><surname>Torabi</surname><name>Fatemeh Torabi</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>aa1b025ec0243f708bb5eb0a93d6fb52</sid><ORCID>0000-0003-0814-0801</ORCID><firstname>Ashley</firstname><surname>Akbari</surname><name>Ashley Akbari</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2024-12-27</date><deptcode>MEDS</deptcode><abstract>Objective To investigate the use of sodium valproate in England and Wales, including during pregnancy, compared with other antiseizure drug treatments, based on national level electronic health records.Design Quantitative analysis of nationwide linked electronic health records.Setting Individual level, population scale data from NHS England's Secure Data Environment, from the British Heart Foundation Data Science Centre's CVD-COVID-UK/COVID-IMPACT Consortium (for England), and the Secure Anonymised Information Linkage Databank (for Wales), 1 January 2019 to 31 December 2023.Participants 1 200 000 individuals dispensed any selected antiseizure drug treatment (ie, sodium valproate, lamotrigine, levetiracetam, carbamazepine, or topiramate); 304 000 women, aged 15-49 years, dispensed any selected antiseizure drug treatment and 28 400 women, aged 15-49 years, dispensed sodium valproate.Main outcome measures Prevalent (current) and incident (new) uses of sodium valproate and other antiseizure drug treatments before and during the covid-19 pandemic (1 January 2019 to 31 December 2023), grouped by age and sex. Pregnancy rates per 1000&#x2009;women, aged 15-49 years, who used antiseizure drug treatments, and timing and dose of sodium valproate dispensed during pregnancy. Geographical variation in use of sodium valproate and disease indications (epilepsy and bipolar affective disorder). Trends in deaths related to epilepsy for 2015-22.Results Prevalent use of sodium valproate in women of childbearing potential decreased and use of most other antiseizure drug treatments increased between 2019 and 2023. Incident use of sodium valproate per 100&#x2009;000&#x2009;women decreased from seven to five in women aged 15-19 years, from 11 to seven in women aged 20-29 years, and from 14 to seven in women aged 30-39 years between 2019 and 2022. Incident use also decreased in men of the same age but remained at much higher levels (from 53 to 43 in men aged 15-19 years, 59 to 47 in men aged 20-29 years, and 57 to 42 in men aged 30-39 years, per 100&#x2009;000 men). Pregnancy rates decreased from 6.0 to 5.2 per 1000&#x2009;women of childbearing potential who were dispensed sodium valproate over the same period. The number of pregnant women who used sodium valproate during pregnancy decreased from 140 in 2019 to 85 in 2023. Epilepsy was the most common indication, followed by bipolar affective disorder (751 and 193 per 1000&#x2009;women of childbearing potential dispensed sodium valproate, respectively, in 2023). No clear evidence was found that deaths related to epilepsy increased in women aged 15-49 during 2015-22, but a slight increase was found in men aged 15-49 during the later period between April 2018 and December 2022.Conclusions Based on comprehensive national records, changes in the dispensing of antiseizure drug treatments in response to regulatory actions were tracked. Rates for use of sodium valproate by women, including during pregnancy, decreased before and continued to slowly decrease during the covid-19 pandemic. Incident use was also reduced in men but remained at much higher levels than in women. This approach, linking national dispensing data to health records at the individual level, could help monitor changes to medicines affected by regulatory changes, including in specific population groups, such as pregnant individuals, and their potential effect on health outcomes.</abstract><type>Journal Article</type><journal>BMJ Medicine</journal><volume>3</volume><journalNumber>1</journalNumber><paginationStart>e000760</paginationStart><paginationEnd/><publisher>BMJ</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2754-0413</issnElectronic><keywords/><publishedDay>20</publishedDay><publishedMonth>12</publishedMonth><publishedYear>2024</publishedYear><publishedDate>2024-12-20</publishedDate><doi>10.1136/bmjmed-2023-000760</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>The British Heart Foundation (BHF) Data Science Centre (grant No SP/19/3/34678, awarded to Health Data Research (HDR) UK) funded co- development (with NHS England) of the Secure Data Environment service for England, provision of linked datasets, data access, user software licences, computational usage, and data management and wrangling support, with additional contributions from the HDR UK Data and Connectivity component of the UK Government Chief Scientific Adviser&#x2019;s National Core Studies programme to coordinate national covid- 19 priority research. Consortium partner organisations funded the time of contributing data analysts, biostatisticians, epidemiologists, and clinicians. This research is part of the Data and Connectivity National Core Study, led by HDR UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant No MC_PC_20058). This work was also supported by the Alan Turing Institute through &#x2018;Towards Turing 2.0&#x2019; Engineering and Physical Sciences Research Council (EPSRC) grant funding. This work was supported by the Con- COV team funded by the Medical Research Council (grant No MR/ V028367/1). This work was supported by HDR UK, which receives its funding from HDR UK (HDR- 9006) funded by the UK Medical Research Council, EPSRC, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), BHF, and the Wellcome Trust. This research has been supported by the Administrative Data Research (ADR) Wales programme of work. ADR Wales, part of the ADR UK investment, unites research expertise from Swansea University Medical School and WISERD (Wales Institute of Social and Economic Research and Data) at Cardiff University with analysts from the Welsh Government. ADR UK is funded by the Economic and Social Research Council (ESRC), part of UK Research and Innovation. This research was supported by ESRC funding, including ADR Wales (ES/W012227/1). This work was supported by the Wales covid- 19 Evidence Centre, funded by Health and Care Research Wales. RS, research professorship, NIHR303160, is funded by the National Institute for Health and Care Research (NIHR) for this research project. The views expressed in this publication are those of the authors and not necessarily those of the NIHR, NHS, or the UK Department of Health and Social Care. DH is supported by the Wellcome Trust (215621/Z/19/Z) and the Medical Research Foundation. AL holds an NIHR funded academic clinical fellowship. FT is funded by HDR UK. CT is supported by a University College London (UCL) UK Research and nnovation (UKRI) Centre for Doctoral Training in artificial intelligence enabled healthcare studentship (EP/S021612/1), MRC Clinical Top- Up, and a studentship from the NIHR Biomedical Research Centre at UCL Hospital NHS Trust. AGM is a NIHR senior investigator and also part funded by NIHR Applied Research Collaboration (ARC) North West Coast.</funders><projectreference/><lastEdited>2025-01-23T16:10:48.5780791</lastEdited><Created>2024-12-27T19:29:33.6245868</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Caroline E</firstname><surname>Dale</surname><orcid>0000-0002-3889-8974</orcid><order>1</order></author><author><firstname>Rohan</firstname><surname>Takhar</surname><order>2</order></author><author><firstname>Yat Yi</firstname><surname>Fan</surname><order>3</order></author><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>4</order></author><author><firstname>Michail</firstname><surname>Katsoulis</surname><order>5</order></author><author><firstname>Samuel</firstname><surname>Kim</surname><order>6</order></author><author><firstname>Andrew</firstname><surname>Lambarth</surname><order>7</order></author><author><firstname>Christopher</firstname><surname>Tomlinson</surname><orcid>0000-0002-0903-5395</orcid><order>8</order></author><author><firstname>Tim</firstname><surname>Wilkinson</surname><orcid>0000-0001-8952-0982</orcid><order>9</order></author><author><firstname>Tanja</firstname><surname>Mueller</surname><orcid>0000-0002-0418-4789</orcid><order>10</order></author><author><firstname>Amanj</firstname><surname>Kurdi</surname><orcid>0000-0001-5036-1988</orcid><order>11</order></author><author><firstname>Mark</firstname><surname>Ashworth</surname><order>12</order></author><author><firstname>Mamas A</firstname><surname>Mamas</surname><order>13</order></author><author><firstname>Kamlesh</firstname><surname>Khunti</surname><order>14</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>15</order></author><author><firstname>Andrew D</firstname><surname>Morris</surname><order>16</order></author><author><firstname>Munir</firstname><surname>Pirmohamed</surname><orcid>0000-0002-7534-7266</orcid><order>17</order></author><author><firstname>Anthony G</firstname><surname>Marson</surname><order>18</order></author><author><firstname>David</firstname><surname>Williams</surname><orcid>0000-0002-8186-9124</orcid><order>19</order></author><author><firstname>David</firstname><surname>Hunt</surname><order>20</order></author><author><firstname>Cathie</firstname><surname>Sudlow</surname><orcid>0000-0002-7725-7520</orcid><order>21</order></author><author><firstname>Reecha</firstname><surname>Sofat</surname><order>22</order></author></authors><documents><document><filename>68622__33393__732e230c0bf94c97a07e02c21fd68d15.pdf</filename><originalFilename>68622.VoR.pdf</originalFilename><uploaded>2025-01-23T16:08:53.3110737</uploaded><type>Output</type><contentLength>1364891</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2025-01-23T16:10:48.5780791 v2 68622 2024-12-27 Use of sodium valproate and other antiseizure drug treatments in England and Wales: quantitative analysis of nationwide linked electronic health records f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 2024-12-27 MEDS Objective To investigate the use of sodium valproate in England and Wales, including during pregnancy, compared with other antiseizure drug treatments, based on national level electronic health records.Design Quantitative analysis of nationwide linked electronic health records.Setting Individual level, population scale data from NHS England's Secure Data Environment, from the British Heart Foundation Data Science Centre's CVD-COVID-UK/COVID-IMPACT Consortium (for England), and the Secure Anonymised Information Linkage Databank (for Wales), 1 January 2019 to 31 December 2023.Participants 1 200 000 individuals dispensed any selected antiseizure drug treatment (ie, sodium valproate, lamotrigine, levetiracetam, carbamazepine, or topiramate); 304 000 women, aged 15-49 years, dispensed any selected antiseizure drug treatment and 28 400 women, aged 15-49 years, dispensed sodium valproate.Main outcome measures Prevalent (current) and incident (new) uses of sodium valproate and other antiseizure drug treatments before and during the covid-19 pandemic (1 January 2019 to 31 December 2023), grouped by age and sex. Pregnancy rates per 1000 women, aged 15-49 years, who used antiseizure drug treatments, and timing and dose of sodium valproate dispensed during pregnancy. Geographical variation in use of sodium valproate and disease indications (epilepsy and bipolar affective disorder). Trends in deaths related to epilepsy for 2015-22.Results Prevalent use of sodium valproate in women of childbearing potential decreased and use of most other antiseizure drug treatments increased between 2019 and 2023. Incident use of sodium valproate per 100 000 women decreased from seven to five in women aged 15-19 years, from 11 to seven in women aged 20-29 years, and from 14 to seven in women aged 30-39 years between 2019 and 2022. Incident use also decreased in men of the same age but remained at much higher levels (from 53 to 43 in men aged 15-19 years, 59 to 47 in men aged 20-29 years, and 57 to 42 in men aged 30-39 years, per 100 000 men). Pregnancy rates decreased from 6.0 to 5.2 per 1000 women of childbearing potential who were dispensed sodium valproate over the same period. The number of pregnant women who used sodium valproate during pregnancy decreased from 140 in 2019 to 85 in 2023. Epilepsy was the most common indication, followed by bipolar affective disorder (751 and 193 per 1000 women of childbearing potential dispensed sodium valproate, respectively, in 2023). No clear evidence was found that deaths related to epilepsy increased in women aged 15-49 during 2015-22, but a slight increase was found in men aged 15-49 during the later period between April 2018 and December 2022.Conclusions Based on comprehensive national records, changes in the dispensing of antiseizure drug treatments in response to regulatory actions were tracked. Rates for use of sodium valproate by women, including during pregnancy, decreased before and continued to slowly decrease during the covid-19 pandemic. Incident use was also reduced in men but remained at much higher levels than in women. This approach, linking national dispensing data to health records at the individual level, could help monitor changes to medicines affected by regulatory changes, including in specific population groups, such as pregnant individuals, and their potential effect on health outcomes. Journal Article BMJ Medicine 3 1 e000760 BMJ 2754-0413 20 12 2024 2024-12-20 10.1136/bmjmed-2023-000760 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee The British Heart Foundation (BHF) Data Science Centre (grant No SP/19/3/34678, awarded to Health Data Research (HDR) UK) funded co- development (with NHS England) of the Secure Data Environment service for England, provision of linked datasets, data access, user software licences, computational usage, and data management and wrangling support, with additional contributions from the HDR UK Data and Connectivity component of the UK Government Chief Scientific Adviser’s National Core Studies programme to coordinate national covid- 19 priority research. Consortium partner organisations funded the time of contributing data analysts, biostatisticians, epidemiologists, and clinicians. This research is part of the Data and Connectivity National Core Study, led by HDR UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant No MC_PC_20058). This work was also supported by the Alan Turing Institute through ‘Towards Turing 2.0’ Engineering and Physical Sciences Research Council (EPSRC) grant funding. This work was supported by the Con- COV team funded by the Medical Research Council (grant No MR/ V028367/1). This work was supported by HDR UK, which receives its funding from HDR UK (HDR- 9006) funded by the UK Medical Research Council, EPSRC, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), BHF, and the Wellcome Trust. This research has been supported by the Administrative Data Research (ADR) Wales programme of work. ADR Wales, part of the ADR UK investment, unites research expertise from Swansea University Medical School and WISERD (Wales Institute of Social and Economic Research and Data) at Cardiff University with analysts from the Welsh Government. ADR UK is funded by the Economic and Social Research Council (ESRC), part of UK Research and Innovation. This research was supported by ESRC funding, including ADR Wales (ES/W012227/1). This work was supported by the Wales covid- 19 Evidence Centre, funded by Health and Care Research Wales. RS, research professorship, NIHR303160, is funded by the National Institute for Health and Care Research (NIHR) for this research project. The views expressed in this publication are those of the authors and not necessarily those of the NIHR, NHS, or the UK Department of Health and Social Care. DH is supported by the Wellcome Trust (215621/Z/19/Z) and the Medical Research Foundation. AL holds an NIHR funded academic clinical fellowship. FT is funded by HDR UK. CT is supported by a University College London (UCL) UK Research and nnovation (UKRI) Centre for Doctoral Training in artificial intelligence enabled healthcare studentship (EP/S021612/1), MRC Clinical Top- Up, and a studentship from the NIHR Biomedical Research Centre at UCL Hospital NHS Trust. AGM is a NIHR senior investigator and also part funded by NIHR Applied Research Collaboration (ARC) North West Coast. 2025-01-23T16:10:48.5780791 2024-12-27T19:29:33.6245868 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Caroline E Dale 0000-0002-3889-8974 1 Rohan Takhar 2 Yat Yi Fan 3 Fatemeh Torabi 0000-0002-5853-4625 4 Michail Katsoulis 5 Samuel Kim 6 Andrew Lambarth 7 Christopher Tomlinson 0000-0002-0903-5395 8 Tim Wilkinson 0000-0001-8952-0982 9 Tanja Mueller 0000-0002-0418-4789 10 Amanj Kurdi 0000-0001-5036-1988 11 Mark Ashworth 12 Mamas A Mamas 13 Kamlesh Khunti 14 Ashley Akbari 0000-0003-0814-0801 15 Andrew D Morris 16 Munir Pirmohamed 0000-0002-7534-7266 17 Anthony G Marson 18 David Williams 0000-0002-8186-9124 19 David Hunt 20 Cathie Sudlow 0000-0002-7725-7520 21 Reecha Sofat 22 68622__33393__732e230c0bf94c97a07e02c21fd68d15.pdf 68622.VoR.pdf 2025-01-23T16:08:53.3110737 Output 1364891 application/pdf Version of Record true This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license. true eng https://creativecommons.org/licenses/by/4.0/
title Use of sodium valproate and other antiseizure drug treatments in England and Wales: quantitative analysis of nationwide linked electronic health records
spellingShingle Use of sodium valproate and other antiseizure drug treatments in England and Wales: quantitative analysis of nationwide linked electronic health records
Fatemeh Torabi
Ashley Akbari
title_short Use of sodium valproate and other antiseizure drug treatments in England and Wales: quantitative analysis of nationwide linked electronic health records
title_full Use of sodium valproate and other antiseizure drug treatments in England and Wales: quantitative analysis of nationwide linked electronic health records
title_fullStr Use of sodium valproate and other antiseizure drug treatments in England and Wales: quantitative analysis of nationwide linked electronic health records
title_full_unstemmed Use of sodium valproate and other antiseizure drug treatments in England and Wales: quantitative analysis of nationwide linked electronic health records
title_sort Use of sodium valproate and other antiseizure drug treatments in England and Wales: quantitative analysis of nationwide linked electronic health records
author_id_str_mv f569591e1bfb0e405b8091f99fec45d3
aa1b025ec0243f708bb5eb0a93d6fb52
author_id_fullname_str_mv f569591e1bfb0e405b8091f99fec45d3_***_Fatemeh Torabi
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
author Fatemeh Torabi
Ashley Akbari
author2 Caroline E Dale
Rohan Takhar
Yat Yi Fan
Fatemeh Torabi
Michail Katsoulis
Samuel Kim
Andrew Lambarth
Christopher Tomlinson
Tim Wilkinson
Tanja Mueller
Amanj Kurdi
Mark Ashworth
Mamas A Mamas
Kamlesh Khunti
Ashley Akbari
Andrew D Morris
Munir Pirmohamed
Anthony G Marson
David Williams
David Hunt
Cathie Sudlow
Reecha Sofat
format Journal article
container_title BMJ Medicine
container_volume 3
container_issue 1
container_start_page e000760
publishDate 2024
institution Swansea University
issn 2754-0413
doi_str_mv 10.1136/bmjmed-2023-000760
publisher BMJ
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Objective To investigate the use of sodium valproate in England and Wales, including during pregnancy, compared with other antiseizure drug treatments, based on national level electronic health records.Design Quantitative analysis of nationwide linked electronic health records.Setting Individual level, population scale data from NHS England's Secure Data Environment, from the British Heart Foundation Data Science Centre's CVD-COVID-UK/COVID-IMPACT Consortium (for England), and the Secure Anonymised Information Linkage Databank (for Wales), 1 January 2019 to 31 December 2023.Participants 1 200 000 individuals dispensed any selected antiseizure drug treatment (ie, sodium valproate, lamotrigine, levetiracetam, carbamazepine, or topiramate); 304 000 women, aged 15-49 years, dispensed any selected antiseizure drug treatment and 28 400 women, aged 15-49 years, dispensed sodium valproate.Main outcome measures Prevalent (current) and incident (new) uses of sodium valproate and other antiseizure drug treatments before and during the covid-19 pandemic (1 January 2019 to 31 December 2023), grouped by age and sex. Pregnancy rates per 1000 women, aged 15-49 years, who used antiseizure drug treatments, and timing and dose of sodium valproate dispensed during pregnancy. Geographical variation in use of sodium valproate and disease indications (epilepsy and bipolar affective disorder). Trends in deaths related to epilepsy for 2015-22.Results Prevalent use of sodium valproate in women of childbearing potential decreased and use of most other antiseizure drug treatments increased between 2019 and 2023. Incident use of sodium valproate per 100 000 women decreased from seven to five in women aged 15-19 years, from 11 to seven in women aged 20-29 years, and from 14 to seven in women aged 30-39 years between 2019 and 2022. Incident use also decreased in men of the same age but remained at much higher levels (from 53 to 43 in men aged 15-19 years, 59 to 47 in men aged 20-29 years, and 57 to 42 in men aged 30-39 years, per 100 000 men). Pregnancy rates decreased from 6.0 to 5.2 per 1000 women of childbearing potential who were dispensed sodium valproate over the same period. The number of pregnant women who used sodium valproate during pregnancy decreased from 140 in 2019 to 85 in 2023. Epilepsy was the most common indication, followed by bipolar affective disorder (751 and 193 per 1000 women of childbearing potential dispensed sodium valproate, respectively, in 2023). No clear evidence was found that deaths related to epilepsy increased in women aged 15-49 during 2015-22, but a slight increase was found in men aged 15-49 during the later period between April 2018 and December 2022.Conclusions Based on comprehensive national records, changes in the dispensing of antiseizure drug treatments in response to regulatory actions were tracked. Rates for use of sodium valproate by women, including during pregnancy, decreased before and continued to slowly decrease during the covid-19 pandemic. Incident use was also reduced in men but remained at much higher levels than in women. This approach, linking national dispensing data to health records at the individual level, could help monitor changes to medicines affected by regulatory changes, including in specific population groups, such as pregnant individuals, and their potential effect on health outcomes.
published_date 2024-12-20T18:59:08Z
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score 11.058631

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