{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T17:11:35Z","timestamp":1788023495707,"version":"build-2784847793"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Teratogenic outcomes associated with valproic acid use represent a substantial concern for persons of childbearing age. Regulatory agencies worldwide have enhanced warnings or implemented risk minimization programs to reduce exposure during pregnancy.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To determine pregnancy rates during valproic acid use and concomitant contraception use across indications.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study used data from the Merative MarketScan commercial claims databases from January 1, 2005, to December 31, 2020, to identify female patients aged 12 to 44 years who initiated valproic acid treatment and had continuous insurance enrollment 6 months before initiation and 9 months after treatment end. A treatment episode included consecutive prescription fills that occurred within 7 days from the end of the days\u2019 supply of the previous dispensing. Data were analyzed from March 1 to September 10, 2023.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Treatment episodes were categorized by inferred indication using diagnoses preceding treatment initiation, including epilepsy, migraine or headache, mood disorders, and unknown or off-label uses. Pregnancy incidence rate ratios (IRRs) were calculated and were adjusted for age and calendar year. Contraceptive use (prescription contraceptives, intrauterine devices, and implants) during treatment was examined.<\/jats:p><\/jats:sec>Results<\/jats:title>The cohort included 165\u202f772 valproic acid treatment episodes among 69\u202f390 women (mean [SD] age, 29.8 [10.0] years). Mood disorders (42.5%) were the most common indication, followed by migraine or headache (20.1%), with epilepsy playing a minor role (14.9%). Pregnancy incidence rates during valproic acid use remained unchanged, with a rate of 1.74 (95% CI, 1.14-2.53) per 100 person-years in 2005 and a rate of 1.90 (95% CI, 1.16-3.12) per 100 person-years in 2019. Compared with epilepsy, pregnancy rates were more than double for mood disorder (IRR, 2.16 [95% CI, 1.93-2.42]) and migraine or headache (IRR, 2.01 [95% CI, 1.92-2.09]). Few treatment episodes coincided with contraceptive use (37 012 [22.3%]), and oral dosage forms were the most common (27 069 [73.1%]).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of patients of childbearing age who used valproic acid, pregnancy rates during valproic acid use did not decrease despite enhanced US Food and Drug Administration safety communications, and contraception use remained low. Patients with migraine and mood disorders accounted for the largest proportion of valproic acid use and had the highest pregnancy rates, while patients with epilepsy had the lowest. These findings suggest a need to enhance efforts to mitigate prenatal exposure to valproic acid, especially for indications where the risk of use during pregnancy outweighs the benefit.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.12680","type":"journal-article","created":{"date-parts":[[2024,5,22]],"date-time":"2024-05-22T15:34:34Z","timestamp":1716392074000},"page":"e2412680","source":"Crossref","is-referenced-by-count":22,"title":["Prenatal Exposure to Valproic Acid Across Various Indications for Use"],"prefix":"10.1001","volume":"7","author":[{"given":"Nicole E.","family":"Smolinski","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville"},{"name":"Center for Drug Evaluation and Safety, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Sarayani","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville"},{"name":"Center for Drug Evaluation and Safety, University of Florida, Gainesville"},{"name":"Now with Janssen Research & Development, LLC, Raritan, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thuy N.","family":"Thai","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville"},{"name":"Center for Drug Evaluation and Safety, University of Florida, Gainesville"},{"name":"Faculty of Pharmacy, HUTECH University (Ho Chi Minh City University of Technology), Ho Chi Minh City, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Jugl","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville"},{"name":"Center for Drug Evaluation and Safety, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celeste L. 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