Valproic acid and contraception use patterns amongst persons assigned female at birth in the United States

Abstract

Specific Aims: To determine the patterns, prevalence, and predictors of valproic acid (VPA) use with or without concurrent contraception among persons assigned female at birth (AFAB) of childbearing age in an ambulatory setting in the United States. Methods: This retrospective, cross-sectional study utilized data from the 2013, 2015, 2017, 2019, and 2021 Medical Expenditure Panel Survey (MEPS) including full-year consolidated data, prescribed medicines, and medical conditions files. The study population consisted of persons AFAB aged 12–49 with a diagnosis of bipolar disorder, epilepsy, or migraine. Participants were categorized into four groups: VPA and contraception, VPA only, contraception only, and neither. Group differences were assessed using chi-squared tests. Results: Among eligible participants, 64.25% had migraine, 25.27% bipolar disorder, and 6.11% epilepsy. VPA use was consistent over time (1.97% in 2013 vs. 1.74% in 2021). A significant proportion of VPA users did not report using contraception (p < 0.001). Those reporting fair or poor mental health had higher rates of VPA with contraception use compared to VPA alone (p = 0.007), suggesting mental health status may influence contraceptive prescribing patterns. Conclusions: Despite teratogenic risks, VPA continues to be prescribed without concurrent contraception to a considerable number of AFAB individuals of childbearing age. The data indicate a need for improved reproductive risk management, particularly through enhanced provider and pharmacist involvement. Future research should explore broader contraceptive methods and include full population data to better estimate national trends.