Date of Award

2021

Embargo Period

8-1-2024

Document Type

Dissertation

Degree Name

Doctor of Health Administration

College

College of Health Professions

First Advisor

Daniel Brinton

Second Advisor

Erin R. Weeda

Third Advisor

Dunc Williams

Abstract

Until recently, there were very little data on the effects of antiepileptic drug (AED) exposure in utero. However, in the past two decades, data from several prospective pregnancy registries have significantly increased the understanding of the critical risks for major congenital malformations associated with several AEDs (Gerard & Meador, 2015). This research examined the risks associated with valproate among women of childbearing age (18-44 years of age) and the risks valproate poses for a child through maternal exposure. The study population came from the 2016-2018 MarketScan® Commercial dataset obtained by the Medical University of South Carolina. In total, there were n=877 women aged 18-44 years of age. There were n=318 women with greater than 3 months prescribed valproate, and there were n=149 women based on 6 month pre-index insurance and 12 months post-index insurance where the data index was the date from which the first valproate prescription was filled. This led to a final cohort size of 149 women. The data was analyzed using measures of central tendency. Tests for differences between those on birth control and those not on birth control were made using Student’s t-test for normally distributed data, Wilcoxon-Mann-Whitney for non-normally distributed data, and chi-squared tests for categorical data. Results include 14.5% of the original population being prescribed valproate for 3 or more months, 33.6% being for migraines, followed by 31.5% for bipolar disorder despite research being conducted primarily for those with epilepsy. In conclusion, the research shows the need for further education on the risks of valproate and women of childbearing age. This is based on the lack of studies focusing on the risks and prescribing patterns outside of the epilepsy community. The research limitations included the length and type of contraceptive use, which the study could not account for as only measurable pregnancy prevention methods were studied. Future research could explore different funding streams as our research focused on commercial payor billing data, which garnered a small sample size.

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