{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T21:33:13Z","timestamp":1783114393048,"version":"3.54.6"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,3,31]],"date-time":"2018-03-31T00:00:00Z","timestamp":1522454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Documented teratogenic effects of valproate (<jats:styled-content style=\"fixed-case\">VPA<\/jats:styled-content>) prompted restrictions of its use in females of childbearing age in 2014. We investigated possible annual changes in the outpatient use of <jats:styled-content style=\"fixed-case\">VPA<\/jats:styled-content> in Finland during 2008\u20132016 with a special focus on women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We identified all outpatients with <jats:styled-content style=\"fixed-case\">VPA<\/jats:styled-content> purchases between 2008 and 2016 categorizing users due to epilepsy, bipolar disorder or miscellaneous indications. Temporal trends in the annual prevalence rates of <jats:styled-content style=\"fixed-case\">VPA<\/jats:styled-content> use were estimated using Poisson regression analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between 2012 and 2016, the prevalence of <jats:styled-content style=\"fixed-case\">VPA<\/jats:styled-content> use among women aged 15\u201344\u00a0years decreased by 19%, from 50\/10\u00a0000 to 40\/10\u00a0000 (prevalence rate ratio, 0.81; 95% confidence intervals, 0.77\u20130.91; <jats:italic>P<\/jats:italic>\u00a0&lt; 0.001). The use of <jats:styled-content style=\"fixed-case\">VPA<\/jats:styled-content> due to epilepsy decreased significantly in females aged 15\u201324 and 25\u201334\u00a0years and that due to bipolar disorders decreased significantly in females aged 25\u201334 and 35\u201344\u00a0years. The use of <jats:styled-content style=\"fixed-case\">VPA<\/jats:styled-content> in the miscellaneous indication group decreased by 32% after 2014 in females aged 15\u201344\u00a0years and, most strikingly, by 56% among those aged 15\u201325\u00a0years. In women with epilepsy, the use of <jats:styled-content style=\"fixed-case\">VPA<\/jats:styled-content> increased among those over the age of 44\u00a0years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The rates of female <jats:styled-content style=\"fixed-case\">VPA<\/jats:styled-content> users with childbearing potential have decreased in all three major indication groups in Finland during recent years, especially after the European Medicines Agency restrictions were published in 2014. However, it still remains open to question as to whether the practice of <jats:styled-content style=\"fixed-case\">VPA<\/jats:styled-content> use follows current guidelines. A special concern is the relatively high prevalence of off\u2010label use of <jats:styled-content style=\"fixed-case\">VPA<\/jats:styled-content> in fertile\u2010aged females.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.13610","type":"journal-article","created":{"date-parts":[[2018,3,6]],"date-time":"2018-03-06T15:32:42Z","timestamp":1520350362000},"page":"869-874","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Declining trend in valproate use in Finland among females of childbearing age in 2012\u20132016 \u2013 a nationwide registry\u2010based outpatient study"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6909-3178","authenticated-orcid":false,"given":"L. 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