Did the French pregnancy pictogram change antiseizure medication use during pregnancy?

The aim of this study was to assess the impact of introducing a pregnancy pictogram on medication packaging on the prescription and dispensation of antiseizure medications and on the maternal and neonatal outcomes for women exposed to these medications.

This is a national retrospective cohort study, based on the French National Health Data System, with a "before/after the introduction of the pictogram" design. Women aged between 15 and 55 years who had a pregnancy outcome between 2014 and 2017 ("before pictogram" period) and between 2018 and 2021 ("after pictogram" period) and who had received at least two antiseizure medication dispensations before their pregnancy were included. We compared the rates of antiseizure medication discontinuation and continuation during pregnancy, the average doses used, and maternal and neonatal outcomes between the two periods.

The rate of women who had received at least two dispensations of a medication indicated for epilepsy before their pregnancy remained stable between the two periods (.7%). There was a significant decrease in valproic acid prescriptions (5.4% vs. 1.3%) during pregnancy and, conversely, an increase in lamotrigine (29.9% vs. 31.5%) and levetiracetam (10.9% vs. 14.5%) prescriptions. Prescriptions by specialists such as neurologists increased significantly (22.8% vs. 28%) between the two periods. There was an increase of more than 2.7% in the continuation of antiseizure medication (37.6% vs. 40.3%, p < .0001) and conversely a decrease in the rate of women who stopped their antiseizure treatment before or during pregnancy in the "after pictogram" period (59.4% vs. 56.7%, p < .0001). Rates of maternal and neonatal outcomes remained similar between the two periods.

The introduction of a pregnancy pictogram in France in 2017 was not associated with an increase in discontinuation of antiseizure medications, less adequate treatment, or poorer maternal or neonatal outcomes in pregnant women receiving these medications before pregnancy.