Skip to Main content Skip to Navigation
Theses

Utilisation des bases de données de l’Assurance Maladie pour l’étude de l’utilisation des antiépileptiques pendant la grossesse et des risques associés à l’exposition in utero chez l’enfant

Abstract : The works of this thesis have been carried out within a programme of pharmacoepidemiological studies initiated by the National Agency of Medicine and Health Product Safety (ANSM) and the National Health Insurance fund (Cnam) in order to evaluate the public health situation in relation to prenatal exposure to valproic acid in France on the basis of the French health care databases. The objective of this thesis was to study antiepileptic drug (AED) use during pregnancy and the risks of congenital malformations and neurodevelopmental disorders associated with prenatal exposure to these drugs. In a first study, we developed an algorithm to identify pregnancy episodes and related outcomes using the French health care claims databases and applied it to study AED use during pregnancy between 2007 and 2014. Over the study period, 6.7 per 1000 pregnancies were exposed to an AED. The use of newer AEDs increased concomitantly with the decreased use of valproic acid and the other older AEDs. In a second study, prenatal exposure to valproic acid was found to be associated with a wide range of malformations among those investigated, with a dose-response relationship for half of them, and prenatal exposure to topiramate with an increased risk of cleft lip with or without cleft palate. Signals concerning pregabalin, clonazepam and phenobarbital have also been identified. In a third study, prenatal exposure to valproic acid was found to be associated with increased risks of all early neurodevelopmental outcomes investigated compared with lamotrigine, with a dose-response relationship. Prenatal exposure to the other AEDs was not associated with an increased risk of any of these neurodevelopmental outcomes versus lamotrigine. Conducting pharmacoepidemiological studies based on the French health care databases enabled the health authorities to rapidly provide data on the use of AED during pregnancy in France. It also brought additional evidence to the international observational literature on the consequences of prenatal exposure to AEDs for the unborn child.
Document type :
Theses
File URL :
http://docnum.univ-lorraine.fr/ulprive/DDOC_T_2019_0053_BLOTIERE.pdf
Complete list of metadatas

https://hal.univ-lorraine.fr/tel-02348024
Contributor : Thèses Ul <>
Submitted on : Tuesday, November 5, 2019 - 12:17:07 PM
Last modification on : Tuesday, October 13, 2020 - 10:48:00 AM

Identifiers

  • HAL Id : tel-02348024, version 1

Citation

Pierre-Olivier Blotière. Utilisation des bases de données de l’Assurance Maladie pour l’étude de l’utilisation des antiépileptiques pendant la grossesse et des risques associés à l’exposition in utero chez l’enfant. Santé publique et épidémiologie. Université de Lorraine, 2019. Français. ⟨NNT : 2019LORR0053⟩. ⟨tel-02348024⟩

Share

Metrics

Record views

22