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

Mélanie Araujo; Christine Damase-Michel; Marie Denuelle; Sébastien Boulogne; Laurane Delteil; Monica Saucedo; Catherine Deneux-Tharaux; Isabelle Lacroix

doi:10.1002/epi.70163

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

Epilepsia. 2026 Mar 9. doi: 10.1002/epi.70163. Online ahead of print.

Authors

Mélanie Araujo¹, Christine Damase-Michel¹, Marie Denuelle², Sébastien Boulogne³, Laurane Delteil¹, Monica Saucedo⁴, Catherine Deneux-Tharaux⁴, Isabelle Lacroix¹

Affiliations

¹ Faculté de Médecine de Toulouse, Centre Hospitalier Universitaire de Toulouse, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR) 1295, Toulouse, France.
² Electrophysiologie Cérébrale, Épilepsie et Sommeil, Hôpital Pierre Paul Riquet, CHU Purpan, Toulouse, France.
³ Service de Neurologie Fonctionnelle et d'épileptologie, Groupement Hospitalier Est-Hôpital Pierre Wertheimer, Bron, France.
⁴ Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (INRAE), Center for Research in Epidemiology and Statistics, Obstetrical Perinatal and Pediatric Life Course Epidemiology, Université Paris Cité, Université Paris Nord, Paris, France.

PMID: 41804083
DOI: 10.1002/epi.70163

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Significance: 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.

Keywords: SNDS database; antiseizure medications; impact study; pictogram; pregnancy.

Abstract

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