{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:42:04Z","timestamp":1787510524339,"version":"build-2736575974"},"reference-count":34,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Journal of Australia"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the frequency of valproate prescribing for female patients of childbearing age at the Royal Children's Hospital, Melbourne, and to assess the frequency of documented discussions with these patients about the teratogenicity of valproate and the discussions or prescribing of contraception.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective audit of hospital electronic medical records data; analysis of Pharmaceutical Benefits Scheme (PBS) valproate dispensing data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting, Participants<\/jats:title>\n                    <jats:p>13\u2010 to 18\u2010year\u2010old girls or women prescribed valproate at the Royal Children's Hospital, Melbourne during 29 May 2022\u201329 May 2024; PBS valproate dispensing data for Australia for the 2023 calendar year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Characteristics of adolescent female patients prescribed valproate; documented discussions of valproate\u2010related teratogenicity, and discussions or prescribing of contraception; population valproate prescribing rates for Australia and by state.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Valproate was prescribed for 245 female patients aged 13\u201318\u2009years during 2022\u20132024 (median age, 16\u2009years; interquartile range [IQR], 14\u201317\u2009years); the median prescribed daily dose was 600\u2009mg (IQR, 400\u2013800\u2009mg; range, 200\u20132000\u2009mg). Valproate was prescribed for treating epilepsy for 221 patients (90%), including 97 (44%) with drug\u2010resistant epilepsy; 160 patients (65%) had neurodevelopmental disabilities. Teratogenicity was discussed with 32 patients (13%), less frequently with patients with a neurodevelopmental disability (9% vs. 20%; odds ratio [OR], 0.41; 95% confidence interval [95% CI], 0.19\u20130.88). Contraception was discussed with 69 patients (28%); the proportion was larger for patients with neurodevelopmental disabilities (34% vs. 16%; OR, 2.66; 95% CI, 1.37\u20135.14). Contraception was prescribed for 50 patients (20%); the proportion was larger for patients with neurodevelopmental disabilities (25% vs. 12%; OR, 2.50; 95% CI, 1.18\u20135.30). The national PBS\u2010subsidised dispensing rate during 2023 was 621 per 100,000 girls and women aged 13\u201318\u2009years; in Victoria it was 556 per 100,000 girls and women aged 13\u201318\u2009years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite the risk of teratogenicity, valproate was prescribed for a considerable number of female adolescents at the Royal Children's Hospital during 2022\u20132024 and across Australia during 2023. Its teratogenicity was discussed with few patients, nor were discussions or prescribing contraception frequent. Contraception was more frequently discussed and prescribed for patients with neurodevelopmental disability, but teratogenicity was discussed less often.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5694\/mja2.70126","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T14:01:32Z","timestamp":1769004092000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Valproate Prescribing for Female Adolescents and Management of the Associated Teratogenicity Risk, Royal Children's Hospital, Melbourne, 2022\u20132024: A Retrospective Audit of Medical Records Data"],"prefix":"10.5694","volume":"224","author":[{"given":"Briana","family":"Davis","sequence":"first","affiliation":[{"name":"The Royal Children's Hospital Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6589-8451","authenticated-orcid":false,"given":"Monica S.","family":"Cooper","sequence":"additional","affiliation":[{"name":"The Royal Children's Hospital Melbourne  Melbourne Victoria Australia"},{"name":"Murdoch Children's Research Institute  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5530-2722","authenticated-orcid":false,"given":"Michael","family":"South","sequence":"additional","affiliation":[{"name":"The Royal Children's Hospital Melbourne  Melbourne Victoria Australia"},{"name":"Murdoch Children's Research Institute  Melbourne Victoria Australia"},{"name":"The University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4184-3683","authenticated-orcid":false,"given":"Jeremy L.","family":"Freeman","sequence":"additional","affiliation":[{"name":"The Royal Children's Hospital Melbourne  Melbourne Victoria Australia"},{"name":"Murdoch Children's Research Institute  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9894-4610","authenticated-orcid":false,"given":"Emma","family":"Macdonald\u2010Laurs","sequence":"additional","affiliation":[{"name":"The Royal Children's Hospital Melbourne  Melbourne Victoria Australia"},{"name":"Murdoch Children's Research Institute  Melbourne Victoria Australia"},{"name":"The University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00314-2"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17241"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001772"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(12)70323-X"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0907328"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30107-8"},{"key":"e_1_2_14_8_1","first-page":"226","article-title":"Women With Intellectual Disabilities: A Study of Sexuality, Sexual Abuse and Protection Skills","volume":"40","author":"Eastgate G.","year":"2011","journal-title":"Australian Family Physician"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001182"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13021"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-020-09809-0"},{"key":"e_1_2_14_12_1","unstructured":"Royal College of Paediatrics and Child Health and the British Paediatric Neurology Association \u201cPrescribing Valproate to Female Patients Under 18\u2009Years of Age \u201dUpdated 31 Jan 2024 accessed Feb 2025 https:\/\/assets.publishing.service.gov.uk\/media\/65f30fcdfa18510011011746\/February_2024_Prescribing_valproate_to_female_patients_under_18_years_of_age.pdf."},{"key":"e_1_2_14_13_1","unstructured":"European Medicines Agency \u201cPRAC Recommends New Measures to Avoid Valproate Exposure in Pregnancy [Media Release] \u201d9 Feb 2018 accessed Jan 2025 https:\/\/www.ema.europa.eu\/en\/news\/prac\u2010recommends\u2010new\u2010measures\u2010avoid\u2010valproate\u2010exposure\u2010pregnancy."},{"key":"e_1_2_14_14_1","unstructured":"Epilepsy Society of Australia \u201cValproate and Women; 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