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Ceulemans M, Van Calsteren K, Allegaert K, Foulon V. Health products' and substance use among pregnant women visiting a tertiary hospital in Belgium: A cross-sectional study. Pharmacoepidemiol Drug Saf 2019; 28:1231-1238. [PMID: 31342605 DOI: 10.1002/pds.4862] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/07/2019] [Accepted: 06/27/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate the prevalence and type of health products used among pregnant women visiting a tertiary hospital in Belgium, as well as who advises these products, where women buy these products, which determinants are associated with medication and pregnancy vitamin intake, and preconception lifestyle changes such as folic acid intake and substance use. METHODS A cross-sectional study was performed at the outpatient obstetrics clinics of the University Hospital Leuven, Belgium between November 2016 and March 2017. All pregnant women 18 years and older and understanding Dutch, French, or English were asked to participate in an online survey. RESULTS In total, 379 pregnant women participated. Prevalence of medication use during the preceding week was 52%. Paracetamol (14%), levothyroxine (13%), and antacids (9%) were the most frequently used medicines. Pregnancy vitamins were used by 86% of women, and 97% had used a pregnancy vitamin somewhere during pregnancy. Only 56% initiated folic acid supplementation at least 1 month before pregnancy. Preconception use of folic acid among women following assisted reproductive technology was 73%. Inappropriate use of health products was observed among 3% of women. Prevalence of alcohol use and/or smoking during the preceding week was 6%. Alcohol and smoking cessation mainly occurred after pregnancy diagnosis. CONCLUSION Pregnant women living in Belgium frequently use medicines, pregnancy vitamins, and other health products. Preconception lifestyle changes such as folic acid intake and alcohol and smoking cessation are poorly implemented. Public campaigns and interventions are needed to improve preconception care and counselling.
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Affiliation(s)
- Michael Ceulemans
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg Leuven, Leuven, Belgium.,Department of Development and Regeneration, Woman and Child, KU Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, Woman and Child, KU Leuven, Leuven, Belgium.,Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
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Tuppin P, Rivière S, Deutsch D, Gastaldi-Menager C, Sabaté JM. Burden of drug use for gastrointestinal symptoms and functional gastrointestinal disorders in France: a national study using reimbursement data for 57 million inhabitants. Therap Adv Gastroenterol 2019; 12:1756284819853790. [PMID: 31320929 PMCID: PMC6628544 DOI: 10.1177/1756284819853790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/08/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Gastrointestinal therapeutic drugs (GTDs) are extensively prescribed. The aim of this study was to investigate the characteristics of GTD use in a large population: the French general health scheme beneficiaries (87% of the 66 million inhabitants) in 2016. METHODS The national health data system was used to identify individual characteristics, diseases and GTD classes reimbursed, together with the costs, using anatomical therapeutic chemical class. RESULTS Among the 57.5 million individuals included, 45% received at least one reimbursement among the 130 million prescriptions reimbursed (90% prescribed by a general practitioner): proton-pump inhibitors (PPI; A02BC: 24%), drugs for functional gastrointestinal disorders (A03: 20%), drugs for constipation (A06: 10%), antidiarrheals, intestinal anti-inflammatory/anti-infective agents (A07: 10%), antiemetics and antinauseants (A04: 7%), other drugs for acid-related disorders (A02X: 6%), other drugs for peptic ulcer and gastro-oesophageal reflux disease (A02BX: 4.5%), antacids (A02A: 1.5%). The overall cost of reimbursed GTDs was €707 million and the mean cost per user was €28. Marked variations were observed according to age, sex, and disease. The rates of at least one reimbursement among infants were A07: 28%, A03: 17%, A02BX: 9%, A02X: 7%, A02BC: 6% and A06: 5%. Women more frequently received a reimbursement than men for each GTD class. Reimbursement rates also varied according to health status (end-stage renal disease A02BC: 66%, pregnancy A03: 53%, A04: 11%), treatments (people with at least six reimbursements for nonsteroidal anti-inflammatory drugs in 2016 A02BC: 62%). Chronic GTD use (>10 reimbursements/year) was observed in 19% of people with at least one A02BC reimbursement, A02BX: 11%, A03: 7%, A04: 2%, A06: 17% and A07: 3%. CONCLUSIONS This study demonstrates extensive and chronic use of GTD in France, raising the question of their relevance according to current guidelines. They must be disseminated to general practitioners, who are the main prescribers of these drugs.
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Affiliation(s)
| | | | - David Deutsch
- Service de Gastroentérologie Hôpital Avicenne,
AP-HP, Bobigny, France
| | | | - Jean-Marc Sabaté
- Service de Gastroentérologie Hôpital Avicenne,
AP-HP, Bobigny, France INSERM U-987, Physiopathologie et Pharmacologie
Clinique de la Douleur, Hôpital Ambroise Paré, Boulogne-Billancourt,
France
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53
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Fältmarch S, Perttilä I, Tuomi U, Kautiainen H, Gissler M, Pennanen P, Eriksson JG, Laine MK. Use of opioids during pregnancy and effects of pregnancy outcomes. Pharmacoepidemiol Drug Saf 2019; 28:1239-1245. [PMID: 31286617 DOI: 10.1002/pds.4848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/16/2019] [Accepted: 05/28/2019] [Indexed: 11/08/2022]
Abstract
PURPOSE To evaluate the use of opioids in pregnant primiparous women and study the effect of opioid use on maternal and offspring delivery outcomes. METHODS The study cohort (N = 6231) consists of all primiparous women with a Finnish background who delivered a singleton between 2009 and 2015 in the city of Vantaa, Finland. Data on births, maternal characteristics, pregnancy outcomes, and purchases of prescription drugs were obtained from National Health Registers. RESULTS Of the primiparous women, 5.1% used opioids during pregnancy. Of these, 95.9% used codeine. No differences were observed in purchases of opioids between the different trimesters but more women purchased opioids as pregnancy progressed (.002). Users of opioids more often also purchased other prescription drugs compared with non-users of opioids, 89% versus 58% (P < .001); age, smoking, education, and body mass index adjusted odds ratio 5.66 (95% confidence interval 3.96 to 8.09). Caesarean sections were more common in users of opioids than in non-users, 28.3% versus 21.9% (.007). Before the age of 7 days, the offspring of users of opioids more often needed respirator treatment compared with the offspring of non-users, 3.1% versus 1.6% (.044). CONCLUSIONS One out of 20 pregnant women used opioids. Use of opioids during pregnancy was associated with the risk for deliveries by caesarean sections and need for respiratory treatment among the offspring during the first week of life. Further safety evaluations are needed.
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Affiliation(s)
- Stella Fältmarch
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Iiro Perttilä
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Mika Gissler
- Information Services Department, Helsinki, Finland.,Department of Neurobiology, Stockholm, Sweden
| | | | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland.,Department of Obstetrics and Gynecology, National University Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Merja K Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Vantaa Health Centre, Vantaa, Finland
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Abstract
Medicine use in pregnancy is extremely common, but there are significant knowledge gaps surrounding the safety, dosage and long-term effects of drugs used. Pregnant women have been purposively excluded from clinical trials of the majority of treatments for conditions that may occur concurrently with pregnancy. There is minimal information on the pharmacokinetics of many existing treatments and no systematic capture of long-term outcome data to help inform choices. Treatments commonly used in pregnancy are thus often old and untested, not optimised in dose, and prescribed off-label without adequate safety information. In addition, there has been a staggering lack of investment in drug development for obstetric conditions for decades. This is a major public health concern, and pregnancy complications are the leading cause of mortality in children under five years old globally, and health in pregnancy is a major determinant of women's long-term health and wellbeing. There is an acute need for adequate investment and legislation to boost inclusion of pregnant women in clinical studies, capture high-quality information on medication use in pregnancy in general, and encourage new medicinal product development for obstetric conditions.
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Affiliation(s)
- Sarah JE Stock
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
| | - Jane E Norman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh BioQuarter, Edinburgh, EH16 4SA, UK
- Faculty of Health Sciences, University of Bristol, 5 Tyndall Avenue, Bristol, UK
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55
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Liang OS, Sheffield JS, Taylor CO. Detecting Patterns of Prescription Drug Use During Pregnancy and Lactation with Visualization Techniques. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2019; 2019:478-487. [PMID: 31259002 PMCID: PMC6568088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Pharmacovigilance studies for the pregnancy population are an important tool to address the teratogenic and maternal effects of prescription drugs. OBJECTIVES We sought to leverage existing data to provide empirical evidence that reflects current drug utilization by pregnant/lactating women for pharmacovigilance and effective study designs. METHODS Temporal patterns of prescription drug use during pregnancy and lactation for four clinical conditions were visualized using a R package and an administrative claims dataset representing nationwide privately-insured women. RESULTS During the years 2010 to 2014, there was a significant increase (p < 0.001) in overall use of opioid, antidepressant, antihypertensive, and antidiabetic prescriptions. Hydrocodone, sertraline, labetalol, and metformin were the most common prescriptions for perinatal use in its respective category. Trimester-specific prescription patterns were reported. CONCLUSIONS Visualization of administrative claims data can quickly detect temporal patterns of prescription drug use during pregnancy and lactation.
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Affiliation(s)
- Ou Stella Liang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- College of Computing and Informatics, Drexel University, Philadelphia, PA
| | | | - Casey Overby Taylor
- Division of General Internal Medicine
- Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, MD
- Corresponding author
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Leong C, Chateau D, Dahl M, Falk J, Katz A, Bugden S, Raymond C. Prescription medication use during pregnancies that resulted in births and abortions (2001-2013): A retrospective population-based study in a Canadian population. PLoS One 2019; 14:e0211319. [PMID: 30840711 PMCID: PMC6402756 DOI: 10.1371/journal.pone.0211319] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 01/12/2019] [Indexed: 11/18/2022] Open
Abstract
We aimed to describe medication use in pregnancies that resulted in births and abortions, as well as use after a pregnancy-related visit to characterize the receipt of medication after knowledge of pregnancy. Abortions included both spontaneous and induced abortions. Rates of medication use among women with a pregnancy outcome (2001–2013) were described using the Manitoba Population Research Data Repository at the Manitoba Centre for Health Policy. Use was determined as ≥ 1 prescription filled during pregnancies that resulted in births (livebirth/stillbirth) and abortions. Rates were calculated at any time during pregnancy and after a pregnancy-related visit. Rates were additionally characterized by risk in pregnancy using Briggs classification (2017). Of 174,848 birth pregnancies, overall 64.9% filled ≥ 1 prescription during pregnancy (a significant increase from 62.3% to 68.8% from 2001–2013, p<0.0001); 55.4% filled ≥ 1 prescription after a pregnancy-related visit. Of 71,967 abortions, 44.7% filled ≥ 1 prescription (a significant increase from 42.6% to 46.8% from 2001–2013, p<0.0001). Only 3.7% of birth pregnancies had at least one prescription for a contraindicated medication (according to Briggs classification), whereas 10.8% of abortions filled a prescription for a contraindicated medication. The most common drugs used in pregnancy were amoxicillin, doxylamine, codeine combinations, nitrofurantoin, cephalexin, salbutamol and ranitidine. Fewer women filled prescriptions for undesirable medications according to Briggs classification during pregnancy after a pregnancy-related visit.
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Affiliation(s)
- Christine Leong
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- * E-mail:
| | - Dan Chateau
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew Dahl
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jamie Falk
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shawn Bugden
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Colette Raymond
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Cavadino A, Prieto‐Merino D, Morris JK. Identifying signals of potentially harmful medications in pregnancy: use of the double false discovery rate method to adjust for multiple testing. Br J Clin Pharmacol 2019; 85:356-365. [PMID: 30350871 PMCID: PMC6339985 DOI: 10.1111/bcp.13799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/26/2018] [Accepted: 10/11/2018] [Indexed: 11/29/2022] Open
Abstract
AIMS Surveillance of medication use in pregnancy is essential to identify associations between first trimester medications and congenital anomalies (CAs). Medications in the same Anatomical Therapeutic Chemical classes may have similar effects. We aimed to use this information to improve the detection of potential teratogens in CA surveillance data. METHODS Data on 15 058 malformed fetuses with first trimester medication exposures from 1995-2011 were available from EUROmediCAT, a network of European CA registries. For each medication-CA combination, the proportion of the CA in fetuses with the medication was compared to the proportion of the CA in all other fetuses in the dataset. The Australian classification system was used to identify high-risk medications in order to compare two methods of controlling the false discovery rate (FDR): a single FDR applied across all combinations, and a double FDR incorporating groupings of medications. RESULTS There were 28 765 potential combinations (523 medications × 55 CAs) for analysis. An FDR cut-off of 50% resulted in a reasonable effective workload, for which single FDR gave rise to eight medication signals (three high-risk medications) and double FDR 50% identified 16 signals (six high-risk). Over a range of FDR cut-offs, double FDR identified more high-risk medications as signals, for comparable effective workloads. CONCLUSIONS The double FDR method appears to improve the detection of potential teratogens in comparison to the single FDR, while maintaining a low risk of false positives. Use of double FDR is recommended in routine signal detection analyses of CA data.
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Affiliation(s)
- Alana Cavadino
- Wolfson Institute of Preventive MedicineQueen Mary University of LondonUK
- Section of Epidemiology and Biostatistics, School of Population HealthUniversity of AucklandNew Zealand
| | - David Prieto‐Merino
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
- Applied Statistics in Medical Research GroupCatholic University of Murcia (UCAM)Spain
| | - Joan K. Morris
- Wolfson Institute of Preventive MedicineQueen Mary University of LondonUK
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Bedewi N, Sisay M, Edessa D. Drug utilization pattern among pregnant women attending maternal and child health clinic of tertiary hospital in eastern Ethiopia: Consideration of toxicological perspectives. BMC Res Notes 2018; 11:858. [PMID: 30514377 PMCID: PMC6280540 DOI: 10.1186/s13104-018-3966-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/29/2018] [Indexed: 02/03/2023] Open
Abstract
Objective This study is aimed to investigate drug utilization pattern among pregnant women attending maternal and child health clinic of tertiary hospital in eastern Ethiopia from March 1 to April 20, 2018. Result A total of 369 pregnant women medical records were reviewed. The mean age of pregnant women was 24.34 (± 4.48) years and the majority of them were within the age of 18-25 years. About three-fourths (n = 277, 75.1%) of them were urban residents. Besides, 314 (85.1%) women had taken at least one drug with a total of 377 drugs prescribed. From which, supplemental drugs accounted majority of the drug therapy (84.88%) whereas non-supplemental drugs (15.12%) were used by 41 pregnant women during the review period. According to Food and Drug Administration FDA pregnancy risk classification, 320 (84.88%) drugs were prescribed from category A; 33 (8.75%) drugs were from category B; 19 (5.04%) drugs were from category C and 5 (1.33%) drugs were from category D. There was no drug prescribed from category X. As this result indicated, there is a decrease in the prevalence of drug use from Category A to X as the possibility of potential risk to fetus might outweigh the potential benefit to the mother. Some drugs were utilized from category D for treatment of chronic illnesses. Electronic supplementary material The online version of this article (10.1186/s13104-018-3966-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Neim Bedewi
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O.Box, 235, Harar, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O.Box, 235, Harar, Ethiopia.
| | - Dumessa Edessa
- Department of Pharmacy Practice, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box, 235, Harar, Ethiopia
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Rouamba T, Valea I, Bognini JD, Kpoda H, Mens PF, Gomes MF, Tinto H, Kirakoya-Samadoulougou F. Safety Profile of Drug Use During Pregnancy at Peripheral Health Centres in Burkina Faso: A Prospective Observational Cohort Study. Drugs Real World Outcomes 2018; 5:193-206. [PMID: 30155832 PMCID: PMC6119166 DOI: 10.1007/s40801-018-0141-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Safety data of many drugs used during pregnancy remain scarce. This is especially true in developing countries characterised by the absence of a robust pharmacovigilance system, high prevalence of different tropical diseases affecting patients and potential for drug-drug interactions. This study aimed to assess the safety profile of drugs used in women at high risk of malaria during pregnancy and delivery in Burkina Faso's health facilities. It also aimed to assess factors associated with the use of potentially risky drugs over the entire course of pregnancy. METHODS We enrolled pregnant women from their first antenatal care visit and followed them up until delivery, and collected data on drug use. Based on United States Food and Drug Administration (FDA) or Australian Therapeutic Goods Administration (TGA) drug risk classification, drugs were classified into three groups: 'probably safe', 'potentially risky' or 'unclassified'. A modified classification was built to take into account national malaria policy treatment guidelines and World Health Organization Malaria Treatment Guidelines recommending malaria chemoprophylaxis during pregnancy. RESULTS Out of 2371 pregnant women enrolled, 56.7% used at least one medication during the entire course of the pregnancy (excluding sulphadoxine-pyrimethamine and iron-folic acid). A total of 101 different types of medications were used by study participants and 36.6, 49.5 and 13.9% were, respectively, classified as 'probably safe', 'potentially risky' and 'unclassified'. Antimalarials and antibiotics were the most frequently used drugs. Around 39% of women used a least one medication classified as potentially risky. However, this proportion dropped to 26% with the modified classification. Living in urban areas and attending the first antenatal care within their first trimester of pregnancy (longer health surveillance) were associated with using 'potentially risky' medications. CONCLUSION This study provides rare and valuable information on the current use of drugs among pregnant women in Burkina Faso. Many pregnant women used medications classified as potentially risky. Our findings suggest the need for rational drug prescription and community education to reduce hazardous drug exposure during pregnancy.
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Affiliation(s)
- Toussaint Rouamba
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium.
- Centre National de la Recherche Scientifique et de la Technologie, Institut de Recherche en Science de la Santé, Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso.
| | - Innocent Valea
- Centre National de la Recherche Scientifique et de la Technologie, Institut de Recherche en Science de la Santé, Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Joel D Bognini
- Centre National de la Recherche Scientifique et de la Technologie, Institut de Recherche en Science de la Santé, Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Herve Kpoda
- Centre Muraz, Département de Recherche Clinique, Bobo-Dioulasso, Burkina Faso
| | - Petra F Mens
- Department of Medical Microbiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Melba F Gomes
- World Health Organization, Avenue Appia, 1211, Geneva 27, Switzerland
| | - Halidou Tinto
- Centre National de la Recherche Scientifique et de la Technologie, Institut de Recherche en Science de la Santé, Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium
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Prescribing antibiotics when the stakes are higher — do GPs prescribe less when patients are pregnant? A retrospective observational study. BJGP Open 2018; 2:bjgpopen18X101505. [PMID: 30564716 PMCID: PMC6184091 DOI: 10.3399/bjgpopen18x101505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/09/2017] [Indexed: 11/15/2022] Open
Abstract
Background Most oral antibiotics are prescribed by GPs, and they are therefore the most important influencers with regard to improving antibiotic prescription patterns. Although GPs’ prescription patterns in general are well-studied, little is known about antibiotic prescription patterns in pregnancy. Aim To study GPs’ antibiotic prescriptions in respiratory tract infections (RTIs) during pregnancy, and assess differences, if any, between pregnant and non-pregnant patients. Design & setting Retrospective observational study combining prescription data from the Norwegian Peer Academic Detailing (Rx-PAD) study database, pregnancy data from the Norwegian birth registry, and pharmacy dispension data from the Norwegian Prescription Database (NorPD). Method Records of patient contacts with 458 GPs, between December 2004 and February 2007, were screened for RTI episodes. Similar diagnoses were grouped together, as were similar antibiotics. Episodes were categorised according to whether the patient was pregnant or not, and included women aged 16–46 years. Logistic regression models were used to assess odds ratios (ORs), and calculated relative risks (cRRs) were produced. The authors also adjusted for clustering at various levels. Results Overall prescription rate for RTI episodes was 30.8% (n = 96 830). The cohort was reduced to include only episodes with women pregnant in the study period (n = 18 890). The antibiotic prescription rate in pregnancy was 25.9% versus 34.2% in the time before and after pregnancy (cRR = 0.66 [95% confidence intervals {CI} = 0.68 to 0.81]). During pregnancy, 83.0% of the antibiotic prescriptions were picked up at a pharmacy, compared to an 86.6% filling rate in non-pregnant patients. The difference was not significant when adjusting for clustering at the patient level. Conclusion Norwegian GPs prescribe fewer antibiotics overall when patients are pregnant and, when they do prescribe, choose more narrow spectrum antibiotics for RTIs. This indicates a possible lower target rate for GP prescriptions to females. A low antibiotic dispension rate during pregnancy may represent a discussion topic in the consultation setting, to address possible reasons and avoid under-treatment.
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Ventura M, Maraschini A, D'Aloja P, Kirchmayer U, Lega I, Davoli M, Donati S. Drug prescribing during pregnancy in a central region of Italy, 2008-2012. BMC Public Health 2018; 18:623. [PMID: 29764430 PMCID: PMC5952470 DOI: 10.1186/s12889-018-5545-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/04/2018] [Indexed: 02/07/2023] Open
Abstract
Background Drug consumption during pregnancy is a matter of concern, especially regarding drugs known or suspected to be teratogens. Little is known about drug use in pregnant women in Italy. The present study is aimed at examining the prevalence, and to detect potential inappropriateness of drug prescribing among pregnant women in Latium, a region of central Italy. Methods This retrospective study was conducted on a cohort of women aged 18-45 years who delivered between 2008 and 2012 in public hospitals. Women were enrolled through the Regional Birth Register. After linking the regional Health Information Systems and the Regional Drug Claims Register, women’s clinical data and prescribed medications were analyzed. Italian Medicine Agency (AIFA) and US Food and Drug Administration (FDA) evidence were used to investigate inappropriate prescribing and teratogenic risk. Results Excluding vitamins and minerals, 80.6% (n = 153,079) of the women were prescribed at least one drug during pregnancy, with an average of 4.6 medications per pregnancy. Drugs for blood and hematopoietic organs were the most commonly prescribed (53.0%,), followed by anti-infectives for systemic use (50.7%). Among the inappropriate prescriptions, progestogen supplementation was given in 20.1% of pregnancies; teratogen drugs were prescribed in 0.8%, mostly angiotensin co-enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) (0.3%). Conclusions In Latium, drugs are widely used in pregnancy. Prescriptions of inappropriate drugs are observed in more than a fifth of pregnancies, and teratogens are still used, despite their known risk. Continuous updates of information provided to practitioners and an increased availability of information to women might reduce inappropriate prescribing.
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Affiliation(s)
- Martina Ventura
- Department of Epidemiology, Latium Regional Health Servigce, Via Cristoforo Colombo, 112, 00147, Rome, Italy.
| | - Alice Maraschini
- National Centre for Diseases Prevention and Health Promotion, Rome, Italy
| | - Paola D'Aloja
- National Centre for Diseases Prevention and Health Promotion, Rome, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Latium Regional Health Servigce, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | - Ilaria Lega
- National Centre for Diseases Prevention and Health Promotion, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Latium Regional Health Servigce, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | - Serena Donati
- National Centre for Diseases Prevention and Health Promotion, Rome, Italy
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Shah M, Bourner L, Ali S, Al-Enazy S, Youssef MM, Fisler M, Rytting E. HPLC Method Development for Quantification of Doxorubicin in Cell Culture and Placental Perfusion Media. SEPARATIONS 2018; 5. [PMID: 29984222 PMCID: PMC6035002 DOI: 10.3390/separations5010009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Assessment of drug transport across the placenta is important in understanding the effect of drugs on placental and fetal health. These phenomena can be studied in both in vitro cell lines and ex vivo placental perfusions. We have successfully developed a sensitive yet simple high performance liquid chromatography (HPLC) method coupled with fluorescence detection to determine the concentration of doxorubicin (DXR) in cell culture media for transport studies in human trophoblast cells (BeWo, b30 clone) and in fetal media for placental perfusion experiments. The method was developed based on a protein precipitation technique and was validated in both media types for linearity, intra-day, and inter-day precision and accuracy. The relationship of peak area to concentration was linear with R2 values of 0.99 or greater obtained over the concentration range of 1.5 to 15,000 ng/mL. Despite the high concentrations of albumin in fetal perfusion media (30 mg/mL), the lower limits of detection and quantification for DXR were found to be 1.5 and 5 ng/mL, respectively. This analytical method may be used to study the transport of DXR across BeWo cells and human placenta during placental perfusion studies.
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Affiliation(s)
- Mansi Shah
- Department of Obstetrics & Gynecology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1062, USA
| | - Luke Bourner
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX 77555-1062, USA
| | - Shariq Ali
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX 77555-1062, USA
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555-1062, USA
| | - Sanaalarab Al-Enazy
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX 77555-1062, USA
| | - Menatallah M. Youssef
- Department of Pharmaceutical Analytical Chemistry, Ain-Shams University, Cairo 1156, Egypt
| | - Morgan Fisler
- Department of Obstetrics & Gynecology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Erik Rytting
- Department of Obstetrics & Gynecology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1062, USA
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX 77555-1062, USA
- Correspondence:
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Kenny LC, Kell DB. Immunological Tolerance, Pregnancy, and Preeclampsia: The Roles of Semen Microbes and the Father. Front Med (Lausanne) 2018; 4:239. [PMID: 29354635 PMCID: PMC5758600 DOI: 10.3389/fmed.2017.00239] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/12/2017] [Indexed: 12/18/2022] Open
Abstract
Although it is widely considered, in many cases, to involve two separable stages (poor placentation followed by oxidative stress/inflammation), the precise originating causes of preeclampsia (PE) remain elusive. We have previously brought together some of the considerable evidence that a (dormant) microbial component is commonly a significant part of its etiology. However, apart from recognizing, consistent with this view, that the many inflammatory markers of PE are also increased in infection, we had little to say about immunity, whether innate or adaptive. In addition, we focused on the gut, oral and female urinary tract microbiomes as the main sources of the infection. We here marshall further evidence for an infectious component in PE, focusing on the immunological tolerance characteristic of pregnancy, and the well-established fact that increased exposure to the father's semen assists this immunological tolerance. As well as these benefits, however, semen is not sterile, microbial tolerance mechanisms may exist, and we also review the evidence that semen may be responsible for inoculating the developing conceptus (and maybe the placenta) with microbes, not all of which are benign. It is suggested that when they are not, this may be a significant cause of PE. A variety of epidemiological and other evidence is entirely consistent with this, not least correlations between semen infection, infertility and PE. Our view also leads to a series of other, testable predictions. Overall, we argue for a significant paternal role in the development of PE through microbial infection of the mother via insemination.
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Affiliation(s)
- Louise C. Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Douglas B. Kell
- School of Chemistry, The University of Manchester, Manchester, United Kingdom
- The Manchester Institute of Biotechnology, The University of Manchester, Manchester, United Kingdom
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Wolgast E, Josefsson A, Josefsson M, Lilliecreutz C, Reis M. Drug use in pregnant women-a pilot study of the coherence between reported use of drugs and presence of drugs in plasma. Eur J Clin Pharmacol 2017; 74:535-539. [PMID: 29264642 PMCID: PMC5849659 DOI: 10.1007/s00228-017-2402-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/08/2017] [Indexed: 02/06/2023]
Abstract
Purpose In Sweden, information on drug use during pregnancy is obtained through an interview and recorded in a standardized medical record at every visit to the antenatal care clinic throughout the pregnancy. Antenatal, delivery, and neonatal records constitute the basis for the Swedish Medical Birth Register (MBR). The purpose of this exploratory study was to investigate the reliability of reported drug use by simultaneous screening for drug substances in the blood stream of the pregnant woman and thereby validate self-reported data in the MBR. Methods Plasma samples from 200 women were obtained at gestational weeks 10–12 and 25 and screened for drugs by using ultra-high performance liquid chromatography with time of flight mass spectrometry (UHPLC-TOF-MS). The results from the analysis were then compared to medical records. Results At the first sampling occasion, the drugs found by screening had been reported by 86% of the women and on the second sampling, 85.5%. Missed reported information was clearly associated with drugs for occasional use. The most common drugs in plasma taken in early and mid-pregnancy were meclizine and paracetamol. Two types of continuously used drugs, selective serotonin reuptake inhibitors and propranolol, were used. All women using them reported it and the drug screening revealed a 100% coherence. Conclusions This study shows good coherence between reported drug intake and the drugs found in plasma samples, which in turn positively validates the MBR.
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Affiliation(s)
- Emelie Wolgast
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Martin Josefsson
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.,Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - Caroline Lilliecreutz
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Margareta Reis
- Department of Clinical Pharmacology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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McLay JS, Izzati N, Pallivalapila AR, Shetty A, Pande B, Rore C, Al Hail M, Stewart D. Pregnancy, prescription medicines and the potential risk of herb-drug interactions: a cross-sectional survey. Altern Ther Health Med 2017; 17:543. [PMID: 29258478 PMCID: PMC5738179 DOI: 10.1186/s12906-017-2052-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 12/07/2017] [Indexed: 12/27/2022]
Abstract
Background Pregnant women are routinely prescribed medicines while self-medicating with herbal natural products to treat predominantly pregnancy related conditions. The aim of this study was to assess the potential for herb-drug interactions (HDIs) in pregnant women and to explore possible herb-drug interactions and their potential clinical significance. Methods A cross-sectional survey of women during early pregnancy or immediately postpartum in North-East Scotland. Outcome measures included; Prescription medicines use excluding vitamins and potential HDIs assessed using Natural Medicines Comprehensive Database. Results The survey was completed by 889 respondents (73% response rate). 45.3% (403) reported the use of at least one prescription medicine, excluding vitamins. Of those taking prescription medicines, 44.9% (181) also reported concurrent use of at least one HNP (Range 1–12). A total of 91 different prescription medicines were reported by respondents using HNPs. Of those taking prescription medicines, 44.9% (181) also reported concurrent use of at least one HNP (Range 1–12). Thirty-four herb-drug interactions were identified in 23 (12.7%) women with the potential to increase the risk of postpartum haemorrhage, alter maternal haemodynamics, and enhance maternal/fetal CNS depression. Almost all were rated as moderate (93.9%), one as a potentially major (ginger and nifedipine) and only one minor (ondansetron and chamomile). Conclusion Almost half of pregnant women in this study were prescribed medicines excluding vitamins and minerals and almost half of these used HNPs. Potential moderate to severe HDIs were identified in an eighth of the study cohort. Healthcare professionals should be aware that the concurrent use of HNPs and prescription medicines during pregnancy is common and carries potential risks.
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De Sousa Mendes M, Lui G, Zheng Y, Pressiat C, Hirt D, Valade E, Bouazza N, Foissac F, Blanche S, Treluyer JM, Urien S, Benaboud S. A Physiologically-Based Pharmacokinetic Model to Predict Human Fetal Exposure for a Drug Metabolized by Several CYP450 Pathways. Clin Pharmacokinet 2017; 56:537-550. [PMID: 27766562 DOI: 10.1007/s40262-016-0457-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pregnant women and their fetuses are exposed to numerous drugs; however, they are orphan populations with respect to the safety and efficacy of drugs. Therefore, the prediction of maternal and fetal drug exposure prior to administration would be highly useful. METHODS A physiologically-based pharmacokinetic (PBPK) model for nevirapine, which is metabolized by the cytochrome P450 (CYP) 3A4, 2B6 and 2D6 pathways, was developed to predict maternal and fetal pharmacokinetics (PK). The model was developed in both non-pregnant and pregnant women, and all physiological and enzymatic changes that could impact nevirapine PK were taken into account. Transplacental parameters estimated from ex vivo human placenta perfusion experiments were included in this PBPK model. To validate the model, observed maternal and cord blood concentrations were compared with predicted concentrations, and the impact of fetal clearance on fetal PK was investigated. RESULTS By implementing physiological changes, including CYP3A4, 2D6 and 2B6 inductions, we predicted a clearance increase of 21 % in late pregnancy. The PBPK model successfully predicted the disposition for both non-pregnant and pregnant populations. Parameters obtained from the ex vivo experiments allowed the prediction of nevirapine concentrations that matched observed cord blood concentrations. The fetal-to-maternal area under the curve ratio (0-24 h interval) was 0.77, and fetal metabolism had no significant effect on fetal PK. CONCLUSIONS The PBPK approach is a useful tool for quantifying a priori the drug exposure of metabolized drugs during pregnancy, and can be applied to evaluate alternative dosing regimens to optimize drug therapy. This approach, including ex vivo human placental perfusion parameters, is a promising approach for predicting human fetal exposure.
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Affiliation(s)
- Maïlys De Sousa Mendes
- EA 7323: Evaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Unité de recherche clinique Paris centre, 75006, Paris, France.
| | - Gabrielle Lui
- EA 7323: Evaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Unité de recherche clinique Paris centre, 75006, Paris, France.,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin-Broca-Hôtel-Dieu-Dieu, 75014, Paris, France
| | - Yi Zheng
- EA 7323: Evaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Unité de recherche clinique Paris centre, 75006, Paris, France.,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin-Broca-Hôtel-Dieu-Dieu, 75014, Paris, France
| | - Claire Pressiat
- EA 7323: Evaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Unité de recherche clinique Paris centre, 75006, Paris, France
| | - Deborah Hirt
- EA 7323: Evaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Unité de recherche clinique Paris centre, 75006, Paris, France.,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin-Broca-Hôtel-Dieu-Dieu, 75014, Paris, France
| | - Elodie Valade
- EA 7323: Evaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Unité de recherche clinique Paris centre, 75006, Paris, France
| | - Naïm Bouazza
- EA 7323: Evaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Unité de recherche clinique Paris centre, 75006, Paris, France
| | - Frantz Foissac
- EA 7323: Evaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Unité de recherche clinique Paris centre, 75006, Paris, France
| | - Stephane Blanche
- EA 7323: Evaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Unité de recherche clinique Paris centre, 75006, Paris, France.,AP-HP, Hôpital Necker-Enfants-malades, Unité d'immunologie, hématologie et rhumatologie pédiatriques, 75015, Paris, France
| | - Jean-Marc Treluyer
- EA 7323: Evaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Unité de recherche clinique Paris centre, 75006, Paris, France.,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin-Broca-Hôtel-Dieu-Dieu, 75014, Paris, France
| | - Saik Urien
- EA 7323: Evaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Unité de recherche clinique Paris centre, 75006, Paris, France.,CIC-1419 Inserm, Cochin-Necker, Paris, France
| | - Sihem Benaboud
- EA 7323: Evaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Unité de recherche clinique Paris centre, 75006, Paris, France.,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin-Broca-Hôtel-Dieu-Dieu, 75014, Paris, France
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Harris GME, Wood M, Eberhard-Gran M, Lundqvist C, Nordeng H. Patterns and predictors of analgesic use in pregnancy: a longitudinal drug utilization study with special focus on women with migraine. BMC Pregnancy Childbirth 2017; 17:224. [PMID: 28705177 PMCID: PMC5512742 DOI: 10.1186/s12884-017-1399-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 07/02/2017] [Indexed: 12/03/2022] Open
Abstract
Background Few studies have investigated the drug utilization patterns and factors predicting drug use in pregnant women with migraine. This longitudinal drug utilization study aimed to describe patterns of analgesic use in a sample of Norwegian pregnant women according to their migraine history, and to identify predictors for analgesic use among these women. Methods Pregnant women giving birth at Akershus University Hospital between 2008 and 2010 were recruited at ultrasound examination in gestational week 17. Data were collected by questionnaires in gestational weeks 17 and 32, and at 8 weeks postpartum, and linked to birth records. Women were grouped into four categories according to migraine history: no migraine history, previous migraine history, recent migraine history (within 1 year prior to pregnancy) and migraine in pregnancy. Patterns of use of analgesics were analyzed descriptively. Multivariable logistic regression was used to identify factors predicting analgesic use. Results Out of 1981 women, 5.0% reported having migraine in pregnancy, 13.2% had a recent history of migraine, 11.5% had a previous history of migraine, and 68.8% reported no history of migraine. Analgesic use declined during pregnancy. Many women switched from triptans and non-steroidal anti-inflammatory drugs to paracetamol, which constituted most of the analgesic use. Factors associated with analgesic use included recent migraine history (OR 1.6, 95% CI 1.2–2.2), more severe headache intensity (OR 1.3, 95% CI 1.3–1.4), smoking (OR 1.9, 95% CI 1.1–3.3) and multiparity (OR 1.4, 95% CI 1.1–1.7). Conclusions Women with migraine stop or switch medications during pregnancy. Analgesic use in pregnancy is affected by migraine characteristics and intensity, and also by socio-demographic factors. Clinicians should bear this in mind when giving advice on adequate management of migraine in pregnancy and safe analgesic use. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1399-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gerd-Marie Eskerud Harris
- Pharmacoepidemiology & Drug Safety Research Group, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box. 1068, Blindern, 0316, Oslo, Norway.
| | - Mollie Wood
- Pharmacoepidemiology & Drug Safety Research Group, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box. 1068, Blindern, 0316, Oslo, Norway
| | - Malin Eberhard-Gran
- Department of Child Health, National Institute of Public Health, Oslo, Norway.,Health Services Research, Research Department, Akershus University Hospital and University of Oslo, Campus Ahus, Lørenskog, Norway
| | - Christofer Lundqvist
- Health Services Research, Research Department, Akershus University Hospital and University of Oslo, Campus Ahus, Lørenskog, Norway
| | - Hedvig Nordeng
- Pharmacoepidemiology & Drug Safety Research Group, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box. 1068, Blindern, 0316, Oslo, Norway.,Department of Child Health, National Institute of Public Health, Oslo, Norway
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Trønnes JN, Lupattelli A, Nordeng H. Safety profile of medication used during pregnancy: results of a multinational European study. Pharmacoepidemiol Drug Saf 2017; 26:802-811. [PMID: 28449197 PMCID: PMC5518438 DOI: 10.1002/pds.4213] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 02/17/2017] [Accepted: 03/21/2017] [Indexed: 11/06/2022]
Abstract
PURPOSE The present study describes the safety profile of medications used during pregnancy across European countries and examines maternal factors associated with the use of risky medications during pregnancy. METHODS This study is based on a multinational, web-based study conducted in 15 European countries from October 2011 to February 2012. Information about maternal demographics, illnesses, and medication use during pregnancy was collected via an electronic questionnaire. Pregnant women and new mothers with a child less than 1-year-old could participate. The Swedish, Australian, and U.S. risk classification systems were used to evaluate medication safety. Descriptive statistics and generalized estimating equation models were used. RESULTS A total of 587 medications were reported by the study sample (n = 6657). Sixty-nine percent of the women used medications classified as safe, 28% used medications classified as risky, and 3% used medications with no classification available. Both socio-demographic and medical factors were associated with the use of risky medications during pregnancy. Having a chronic disorder was the factor with the strongest association with the use of risky medications during pregnancy (adjusted odds ratio = 3.99, 95% confidence interval 3.54-4.49). CONCLUSIONS The majority of women used medications classified as safe to use during pregnancy. However, a considerable proportion of women still used medications classified as risky. Having a chronic disorder was an important driver for using risky medications. Such use may still be appropriate when considering the woman's underlying condition. Pre-pregnancy counselling is important to ensure safe medication use for both mother and child. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Johanne N Trønnes
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
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Daud ANA, Bergsma EL, Bergman JEH, De Walle HEK, Kerstjens-Frederikse WS, Bijker BJ, Hak E, Wilffert B. Knowledge and attitude regarding pharmacogenetics among formerly pregnant women in the Netherlands and their interest in pharmacogenetic research. BMC Pregnancy Childbirth 2017; 17:120. [PMID: 28410576 PMCID: PMC5391584 DOI: 10.1186/s12884-017-1290-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 03/23/2017] [Indexed: 11/29/2022] Open
Abstract
Background Pharmacogenetics is an emerging field currently being implemented to improve safety when prescribing drugs. While many women who take drugs during pregnancy would likely benefit from such personalized drug therapy, data is lacking on the awareness towards pharmacogenetics among women. We aim to determine the level of knowledge and acceptance of formerly pregnant women in the Netherlands regarding pharmacogenetics and its implementation, and their interest in pharmacogenetic research. Methods A population-based survey using postal questionnaires was conducted among formerly pregnant women in the Northern parts of the Netherlands. A total of 986 women were invited to participate. Results Of the 219 women who returned completed questionnaires (22.2% response rate), only 22.8% had heard of pharmacogenetics, although the majority understood the concept (64.8%). Women who had experience with drug side-effects were more likely to know about pharmacogenetics [OR = 2.06, 95% CI 1.16, 3.65]. Of the respondents, 53.9% were positive towards implementing pharmacogenetics in their future drug therapy, while 46.6% would be willing to participate in pharmacogenetic research. Among those who were either not willing or undecided in this regard, their concerns were about the consequences of the pharmacogenetic test, including the privacy and anonymity of their genetic information. Conclusion The knowledge and attitude regarding the concept of pharmacogenetics among our population of interest is good. Also, their interest in pharmacogenetic research provides opportunities for future research related to drug use during pregnancy and fetal outcome. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1290-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aizati N A Daud
- Department of Pharmacy, University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics, 9713AV, Groningen, The Netherlands. .,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Discipline of Clinical Pharmacy, 11800, Penang, Malaysia.
| | - Eefke L Bergsma
- Department of Pharmacy, University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics, 9713AV, Groningen, The Netherlands
| | - Jorieke E H Bergman
- Department of Genetics, University of Groningen, University Medical Center Groningen, 9713GZ, Groningen, The Netherlands
| | - Hermien E K De Walle
- Department of Genetics, University of Groningen, University Medical Center Groningen, 9713GZ, Groningen, The Netherlands
| | | | - Bert J Bijker
- Department of Pharmacy, University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics, 9713AV, Groningen, The Netherlands
| | - Eelko Hak
- Department of Pharmacy, University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics, 9713AV, Groningen, The Netherlands
| | - Bob Wilffert
- Department of Pharmacy, University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics, 9713AV, Groningen, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, 9713GZ, Groningen, The Netherlands
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Drug Use before and during Pregnancy in Japan: The Japan Environment and Children's Study. PHARMACY 2017; 5:pharmacy5020021. [PMID: 28970433 PMCID: PMC5597146 DOI: 10.3390/pharmacy5020021] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 04/02/2017] [Accepted: 04/05/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose: To elucidate drug use before and during pregnancy in Japan. Methods: The Japan Environment and Children's Study (JECS) is an ongoing nationwide birth cohort study. We analyzed data from JECS involving cases where drugs were used for 12 months before pregnancy was diagnosed, between the time of diagnosis of pregnancy until week 12 of pregnancy, and after week 12 of pregnancy. Results: We analyzed data from 97,464 pregnant women. The percentages of pregnant women who had taken one or more drugs and supplements before diagnosis of pregnancy, between the time of diagnosis of pregnancy until week 12 of pregnancy, and after week 12 of pregnancy, were 78.4%, 57.1%, and 68.8% respectively. Excluding iron supplements, folic acid, and other vitamins and minerals, the percentages of women taking supplements were 75.3%, 36.0%, and 51.7% at each respective time point. The following drugs and supplements were frequently used for 12 months before pregnancy diagnosis: Commercially available antipyretics, analgesics, and/or medicine for treating common cold (34.7%), antipyretics, analgesics, and/or medicine for treating common colds, which were prescribed in hospitals (29.8%), antimicrobial drugs (14.0%), and anti-allergy drugs (12.5%). The following drugs and supplements were frequently used from the time of pregnancy diagnosis until week 12 of pregnancy, and after week 12 of pregnancy: folic acid (28.9% and 26.2%), antipyretics, analgesics and/or medicines for treating common cold, that were prescribed in hospitals (7.8% and 13.3%), Chinese herbal medicines (6.0% and 9.4%, and uterine relaxants (5.1% and 15.2%). Conclusions: The analysis of a nationwide cohort study showed that a high percentage of Japanese pregnant women were taking medicinal drugs. Further research is required to elucidate the relationship between drug use during pregnancy and birth defects in Japan.
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Al-Hamimi JZ, Al Balushi KA. Patterns of prescription drugs use among pregnant women at Sultan Qaboos University Hospital and Sultan Qaboos University Hospital Family and Community Medicine Clinic, Oman. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2017; 8:309-313. [PMID: 28216955 PMCID: PMC5314830 DOI: 10.4103/0975-7406.199347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: This study evaluates the patterns of prescription drugs use among women attending antenatal clinic at Sultan Qaboos University Hospital (SQUH) and SQUH Family and Community Medicine clinic (FAMCO), Oman. Methods: The study was a descriptive retrospective cross-sectional study on pregnant women who attended the antenatal clinic at SQUH and FAMCO from February to April 2014 and received a prescription containing at least one drug. Patients’ information was extracted from SQUH electronic records. Results: A total of 105 pregnant women were included in the study. Among the recruited pregnant women, 35 (33.3%) had at least one chronic disease. The average number of drugs prescribed per patient per prescription during the period of pregnancy was 2.33 ± 1.43. Vitamins and minerals were the most frequently prescribed class of drugs (30.60%) followed by analgesics (11.19%) and antidiabetic drugs (10.13%). According to the Food and Drug Administration risk classification, most of the prescribed drugs were from category B (30.0%) and C (27.14%). No drug was prescribed from category X. There was a significant decrease in prescribing category A drugs over the three trimesters (20.7%, 12.7%, and 9.3%, respectively) (P < 0.047). Conclusion: The study gives an overview of the extent of drug prescription during pregnancy and increases the awareness of health-care providers and women about the potential risks of drug use during pregnancy.
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Affiliation(s)
- J Z Al-Hamimi
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Al Khoud, Muscat, Oman
| | - K A Al Balushi
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Al Khoud, Muscat, Oman
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Adverse drug reactions in high-risk pregnant women: A prospective study. Saudi Pharm J 2017; 25:1073-1077. [PMID: 29158717 PMCID: PMC5681315 DOI: 10.1016/j.jsps.2017.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 01/25/2017] [Indexed: 11/22/2022] Open
Abstract
Background Because pregnant women are often excluded from clinical trials, there is still very limited information about the risk and safety of prescription drugs during pregnancy. Objective We aimed to determine the prevalence of Adverse Drug Reactions (ADRs) in high-risk pregnant women after hospital admission. A prospective study was carried out in a teaching maternity hospital in Brazil during six months. Causality of ADRs was assessed through the Naranjo Algorithm and Korean Algorithm for ADR Causality Assessment. Severity of ADRs was assessed using Hartwig’s Severity Assessment Scale. Results The prevalence of ADRs among the 294 inpatients studied was 8.8%. The mean age was 27.14 (±7.5) y.o. Patient's age was related to the presence of ADRs, while the manifestation of these events was not associated with any adverse pregnancy outcome. 75.9% of the ADRs reported in the study were of mild severity and 24.1% were of moderate severity. No ADR was caused by drug-drug interaction; however, a significant increase in blood pressure was observed in all patients using concurrent methyldopa and ferrous sulfate. Conclusion Overall, ADRs were not common events among high-risk pregnant women and no adverse pregnancy outcomes following these events were observed.
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Singal D, Brownell M, Chateau D, Ruth C, Katz LY. Neonatal and childhood neurodevelopmental, health and educational outcomes of children exposed to antidepressants and maternal depression during pregnancy: protocol for a retrospective population-based cohort study using linked administrative data. BMJ Open 2016; 6:e013293. [PMID: 27899401 PMCID: PMC5168512 DOI: 10.1136/bmjopen-2016-013293] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Antidepressants are commonly prescribed during pregnancy; however, there are inconsistent data on the safety of these medications during the prenatal period. To address this gap, this study will investigate short-term and long-term neurodevelopmental, physical and mental health, and educational outcomes of children who have been exposed to selective serotonin reuptake inhibitors (SSRIs) or selective serotonin norepinephrine reuptake inhibitors (SNRIs) and/or maternal depression during pregnancy. METHODS AND ANALYSIS Administrative data will be linked to generate 4 population-based exposed groups from all children born in Manitoba between 1996 and 2014 whose mother had at least 2 prescriptions for either an SSRI or SNRI: (1) throughout the prenatal period (beginning of pregnancy until birth); (2) in the first trimester (≤14 weeks gestation); (3) in the second trimester (15-26 weeks gestation); (4) in the third trimester (≥27 weeks gestation) and 1 population-based unexposed group consisting of children whose mothers had a diagnosis of mood or anxiety disorder during pregnancy but did not use antidepressants. Propensity scores and inverse probability treatment weights will be used to adjust for confounding. Multivariate regression modelling will determine whether, compared with untreated mood/anxiety disorder, prenatal exposure to antidepressant medications is associated with: (1) adverse birth and neonatal outcomes, including: preterm birth, low birth weight, low Apgar scores, respiratory distress, congenital malformations and persistent pulmonary hypertension; (2) adverse early childhood outcomes, including: early childhood education challenges, diagnosis of neurodevelopmental disorders and diagnosis of mental disorders. We will determine if exposure effects differ between SSRIs and SRNIs, and determine if exposure effects differ between gestation timing of exposure to antidepressants. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Manitoba Health Research Ethics Board. Dissemination of results will include engagement of stakeholders and patients, writing of reports for policymakers and patients, and publication of scientific papers.
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Affiliation(s)
- Deepa Singal
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marni Brownell
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsea Ruth
- Department of Paediatrics and Child Health, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laurence Y Katz
- Department of Psychiatry, Child and Adolescent Mental Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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Given JE, Loane M, Luteijn JM, Morris JK, de Jong van den Berg LTW, Garne E, Addor MC, Barisic I, de Walle H, Gatt M, Klungsoyr K, Khoshnood B, Latos-Bielenska A, Nelen V, Neville AJ, O'Mahony M, Pierini A, Tucker D, Wiesel A, Dolk H. EUROmediCAT signal detection: an evaluation of selected congenital anomaly-medication associations. Br J Clin Pharmacol 2016; 82:1094-109. [PMID: 27028286 PMCID: PMC5137835 DOI: 10.1111/bcp.12947] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 12/30/2022] Open
Abstract
AIMS To evaluate congenital anomaly (CA)-medication exposure associations produced by the new EUROmediCAT signal detection system and determine which require further investigation. METHODS Data from 15 EUROCAT registries (1995-2011) with medication exposures at the chemical substance (5th level of Anatomic Therapeutic Chemical classification) and chemical subgroup (4th level) were analysed using a 50% false detection rate. After excluding antiepileptics, antidiabetics, antiasthmatics and SSRIs/psycholeptics already under investigation, 27 associations were evaluated. If evidence for a signal persisted after data validation, a literature review was conducted for prior evidence of human teratogenicity. RESULTS Thirteen out of 27 CA-medication exposure signals, based on 389 exposed cases, passed data validation. There was some prior evidence in the literature to support six signals (gastroschisis and levonorgestrel/ethinylestradiol (OR 4.10, 95% CI 1.70-8.53; congenital heart disease/pulmonary valve stenosis and nucleoside/tide reverse transcriptase inhibitors (OR 5.01, 95% CI 1.99-14.20/OR 28.20, 95% CI 4.63-122.24); complete absence of a limb and pregnen (4) derivatives (OR 6.60, 95% CI 1.70-22.93); hypospadias and pregnadien derivatives (OR 1.40, 95% CI 1.10-1.76); hypospadias and synthetic ovulation stimulants (OR 1.89, 95% CI 1.28-2.70). Antipropulsives produced a signal for syndactyly while the literature revealed a signal for hypospadias. There was no prior evidence to support the remaining six signals involving the ordinary salt combinations, propulsives, bulk-forming laxatives, hydrazinophthalazine derivatives, gonadotropin releasing hormone analogues and selective serotonin agonists. CONCLUSION Signals which strengthened prior evidence should be prioritized for further investigation, and independent evidence sought to confirm the remaining signals. Some chance associations are expected and confounding by indication is possible.
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Affiliation(s)
- Joanne E Given
- Centre for Maternal, Fetal and Infant Research, Institute of Nursing and Health Research, Ulster University, United Kingdom
| | - Maria Loane
- Centre for Maternal, Fetal and Infant Research, Institute of Nursing and Health Research, Ulster University, United Kingdom
| | - Johannes M Luteijn
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom
| | - Joan K Morris
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom
| | | | - Ester Garne
- Paediatric Department, Hospital Lillebaelt, Kolding, Denmark
| | | | - Ingeborg Barisic
- Department of Medical Genetics and Reproductive Health, Children's University Hospital Zagreb, Croatia
| | - Hermien de Walle
- Eurocat Northern Netherlands, University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, the Netherlands
| | - Miriam Gatt
- Department of Health Information and Research, Guardamangia, Malta
| | - Kari Klungsoyr
- Medical Birth Registry of Norway, the Norwegian Institute of Public Health and Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Babak Khoshnood
- Paris Registry of Congenital Anomalies, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Biostatistics and Epidemiology, INSERM U1153, Maternité de Port-Royal, PARIS, France
| | - Anna Latos-Bielenska
- Polish Registry of Congenital Malformations, Department of Medical Genetics, Poznan, Poland
| | - Vera Nelen
- Provinciaal Instituut voor Hygiene (PIH), Antwerp, Belgium
| | - Amanda J Neville
- IMER Registry (Emilia Romagna Registry of Birth Defects), Centre for Clinical and Epidemiological Research, University of Ferrara and Azienda Ospedaliero Univerisitarion di Ferrara, Italy
| | | | - Anna Pierini
- Epidemiology and Health Promotion Macro-Area Working Group, Unit of Environmental Epidemiology and Disease Registries, CNR Institute of Clinical Physiology, Pisa, Italy
| | - David Tucker
- CARIS - Congenital Anomaly Register and Information Service for Wales, Public Health Wales, Swansea, United Kingdom
| | - Awi Wiesel
- Mainz Model Birth Registry, University Children's Hospital Mainz, Germany
| | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, Institute of Nursing and Health Research, Ulster University, United Kingdom.
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Daud ANA, Bergman JEH, Bakker MK, Wang H, Kerstjens-Frederikse WS, de Walle HEK, Groen H, Bos JHJ, Hak E, Wilffert B. P-Glycoprotein-Mediated Drug Interactions in Pregnancy and Changes in the Risk of Congenital Anomalies: A Case-Reference Study. Drug Saf 2016; 38:651-9. [PMID: 26017034 PMCID: PMC4486783 DOI: 10.1007/s40264-015-0299-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction Drug use in pregnancy is very common but may cause harm to the fetus. The teratogenic effect of a drug is partly dependent on the drug level in the fetal circulation, which is associated with the transport across the placenta. Many drugs are substrates of P-glycoprotein (P-gp), an efflux transporter that acts as a protective barrier for the fetus. We aim to identify whether drug interactions associated with P-gp promote any changes in fetal drug exposure, as measured by the risk of having children with congenital anomalies. Methods In this study, cases (N = 4634) were mothers of children with congenital anomalies registered in the EUROCAT Northern Netherlands registry, and the reference population were mothers of children (N = 25,126) from a drug prescription database (IADB.nl). Results Drugs that are associated with P-gp transport were commonly used in pregnancy in cases (10 %) and population (12 %). Several drug classes, which are substrates for P-gp, were shown to have a higher user rate in mothers of cases with specific anomalies. The use of this subset of drugs in combination with other P-gp substrates increased the risk for specific anomalies (odds ratio [OR] 4.17, 95 % CI 1.75–9.91), and the addition of inhibitors further increased the risk (OR 13.03, 95 % CI 3.37–50.42). The same pattern of risk increment was observed when the drugs were analyzed separately according to substrate specificity. Conclusions The use of drugs associated with P-gp transport was common during pregnancy. For several drug classes associated with specific anomalies, P-gp-mediated drug interactions are associated with an increased risk for those specific anomalies. Electronic supplementary material The online version of this article (doi:10.1007/s40264-015-0299-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aizati N A Daud
- Unit of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy, University of Groningen, Groningen, The Netherlands,
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Richardson JL, Stephens S, Thomas SHL, Jamry-Dziurla A, de Jong-van den Berg L, Zetstra-van der Woude P, Laursen M, Hliva V, Mt-Isa S, Bourke A, Dreyer NA, Blackburn SC. An International Study of the Ability and Cost-Effectiveness of Advertising Methods to Facilitate Study Participant Self-Enrolment Into a Pilot Pharmacovigilance Study During Early Pregnancy. JMIR Public Health Surveill 2016; 2:e13. [PMID: 27227148 PMCID: PMC4869218 DOI: 10.2196/publichealth.5366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/12/2016] [Accepted: 01/17/2016] [Indexed: 11/13/2022] Open
Abstract
Background Knowledge of the fetal effects of maternal medication use in pregnancy is often inadequate and current pregnancy pharmacovigilance (PV) surveillance methods have important limitations. Patient self-reporting may be able to mitigate some of these limitations, providing an adequately sized study sample can be recruited. Objective To compare the ability and cost-effectiveness of several direct-to-participant advertising methods for the recruitment of pregnant participants into a study of self-reported gestational exposures and pregnancy outcomes. Methods The Pharmacoepidemiological Research on Outcomes of Therapeutics by a European Consortium (PROTECT) pregnancy study is a non-interventional, prospective pilot study of self-reported medication use and obstetric outcomes provided by a cohort of pregnant women that was conducted in Denmark, the Netherlands, Poland, and the United Kingdom. Direct-to-participant advertisements were provided via websites, emails, leaflets, television, and social media platforms. Results Over a 70-week recruitment period direct-to-participant advertisements engaged 43,234 individuals with the study website or telephone system; 4.78% (2065/43,234) of which were successfully enrolled and provided study data. Of these 90.4% (1867/2065) were recruited via paid advertising methods, 23.0% (475/2065) of whom were in the first trimester of pregnancy. The overall costs per active recruited participant were lowest for email (€23.24) and website (€24.41) advertisements and highest for leaflet (€83.14) and television (€100.89). Website adverts were substantially superior in their ability to recruit participants during their first trimester of pregnancy (317/668, 47.5%) in comparison with other advertising methods (P<.001). However, we identified international variations in both the cost-effectiveness of the various advertisement methods used and in their ability to recruit participants in early pregnancy. Conclusions Recruitment of a pregnant cohort using direct-to-participant advertisement methods is feasible, but the total costs incurred are not insubstantial. Future research is needed to identify advertising strategies capable of recruiting large numbers of demographically representative pregnant women, preferentially in early pregnancy.
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Affiliation(s)
- Jonathan Luke Richardson
- The UK Teratology Information ServiceNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUnited Kingdom.,Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Sally Stephens
- The UK Teratology Information ServiceNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUnited Kingdom.,Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Simon Hugh Lynton Thomas
- The UK Teratology Information ServiceNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUnited Kingdom.,Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Anna Jamry-Dziurla
- Department of Medical GeneticsPoznan University of Medical SciencesPoznanPoland
| | - Lolkje de Jong-van den Berg
- Unit of PharmacoEpidemiology and PharmacoEconomicsDepartment of PharmacyUniversity of GroningenGroningenNetherlands
| | | | - Maja Laursen
- Department of Data Delivery and Medicinal Product StatisticsThe Danish Health Data AuthorityCopenhagenDenmark
| | - Valerie Hliva
- Quintiles Real-World and Late Phase ResearchSt. PrexSwitzerland
| | - Shahrul Mt-Isa
- Imperial Clinical Trials UnitSchool of Public HealthImperial College LondonLondonUnited Kingdom
| | - Alison Bourke
- Real World Evidence SolutionsIMS HealthLondonUnited Kingdom
| | - Nancy A Dreyer
- Quintiles Real-World & Late Phase ResearchCambridge, MAUnited States
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Smith MV, Costello D, Yonkers KA. Clinical correlates of prescription opioid analgesic use in pregnancy. Matern Child Health J 2016; 19:548-56. [PMID: 24951127 DOI: 10.1007/s10995-014-1536-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 2012 committee opinion from the American College of Obstetricians and Gynecologists highlights the considerable increase in opioid addiction in recent years, yet little is known about clinical correlates of prescribed opioids among pregnant women. This study examines clinical and demographic factors associated with the use of opioid analgesics in pregnancy. Data were derived from a prospective cohort study of pregnant women. Participants were administered the Composite International Diagnostic Interview to identify depressive and anxiety disorders and data on medication use were gathered at three assessment points and classified according to the Anatomical Therapeutic Chemical Code (ATC) classification system ATC group N02A. Participants included 2,748 English or Spanish speaking pregnant women. Six percent (n = 165) of women used opioid analgesics at any point in pregnancy. More pregnant women using opioids met diagnostic criteria for major depressive disorder (16 vs. 8 % for non users), generalized anxiety disorder (18 vs. 9 % for non users), post-traumatic stress disorder (11 vs. 4 % for non users) and panic disorder (6 vs. 4 % for non users). Women who reported opioid use were also significantly more likely than non users to report using illicit drugs and almost three times as likely to report smoking cigarettes in the second or third trimester of pregnancy (4 and 23 %, respectively) as compared to non-opioid users (0.5 and 8 %). The use of opioids in pregnancy was associated with higher levels of psychiatric comorbidity and use of other substances as compared to non-opioid users.
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Affiliation(s)
- Megan V Smith
- Department of Psychiatry, Yale School of Medicine, 300 George Street, 9th floor, New Haven, CT, 06511, USA,
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Prevalence of prescription medication use among non-pregnant women of childbearing age and pregnant women in the United States: NHANES, 1999-2006. Matern Child Health J 2016; 19:1097-106. [PMID: 25287251 DOI: 10.1007/s10995-014-1611-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Many prescription medications have limited information regarding safety for use during pregnancy. In order to inform research on safer medication use during pregnancy, we examined prescription medication use among women in the United States. We analyzed data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) to estimate the prevalence of prescription medication use in the past 30 days among pregnant women and non-pregnant women of childbearing age (15-44 years) and to ascertain the most commonly reported prescription medications by women in these groups. We assessed how the most commonly reported medications differed among groups defined by selected demographic characteristics, including age, race/ethnicity, and markers of socioeconomic status. Prescription medication use in the past 30 days was reported by 22 % of pregnant women and 47 % of non-pregnant women of childbearing age. The most commonly reported prescription medications by NHANES participants differed somewhat by pregnancy status; allergy and anti-infective medications were more common among pregnant women, while oral contraceptives were more common among non-pregnant women. Use of prescription medication for asthma and thyroid disorders was reported by both groups. Although prescription medication use in the previous 30 days was less common among pregnant women than non-pregnant women, its use was reported among almost 1 in 4 pregnant women. Many of the most common medications reported were for the treatment of chronic medical conditions. Given the potential impact of medications on the developing fetus, our data underscore the importance of understanding the safety of these medications during pregnancy.
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Sinclair SM, Miller RK, Chambers C, Cooper EM. Medication Safety During Pregnancy: Improving Evidence-Based Practice. J Midwifery Womens Health 2016; 61:52-67. [PMID: 26771055 DOI: 10.1111/jmwh.12358] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 11/30/2022]
Abstract
Nearly 90% of women in the United States have taken medications during pregnancy. Medication exposures during pregnancy can result in adverse pregnancy and neonatal outcomes including birth defects, fetal loss, intrauterine growth restriction, prematurity, and longer-term neurodevelopmental outcomes. Advising pregnant women about the safety of medication use during pregnancy is complicated by a lack of data necessary to engage the woman in an informed discussion. Routinely, health care providers turn to the package insert, yet this information can be incomplete and can be based entirely on animal studies. Often, adequate safety data are not available. In a busy clinical setting, health care providers need to be able to quickly locate the most up-to-date information in order to counsel pregnant women concerned about medication exposure. Deciding where to locate the best available information is difficult, particularly when the needed information does not exist. Pregnancy registries are initiated to obtain more data about the safety of specific medication exposures during pregnancy; however, these studies are slow to produce meaningful information, and when they do, the information may not be readily available in a published form. Health care providers have valuable data in their everyday practice that can expand the knowledge base about medication safety during pregnancy. This review aims to discuss the limitations of the package insert regarding medication safety during pregnancy, highlight additional resources available to health care providers to inform practice, and communicate the importance of pregnancy registries for expanding knowledge about medication safety during pregnancy.
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Pisa FE, Casetta A, Clagnan E, Michelesio E, Vecchi Brumatti L, Barbone F. Medication use during pregnancy, gestational age and date of delivery: agreement between maternal self-reports and health database information in a cohort. BMC Pregnancy Childbirth 2015; 15:310. [PMID: 26608022 PMCID: PMC4660837 DOI: 10.1186/s12884-015-0745-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Health databases are a promising resource for epidemiological studies on medications safety during pregnancy. The reliability of information on medications exposure and pregnancy timing is a key methodological issue. This study (a) compared maternal self-reports and database information on medication use, gestational age, date of delivery; (b) quantified the degree of agreement between sources; (c) assessed predictors of agreement. Methods Pregnant women recruited in a prenatal clinic in Friuli Venezia Giulia (FVG) region, Italy, from 2007 to 2009, completed a questionnaire inquiring on medication use during pregnancy, gestational age and date of delivery. Redeemed prescriptions and birth certificate records were extracted from regional databases through record linkage. Percent agreement, Kappa coefficient, prevalence and bias-adjusted Kappa (PABAK) were calculated. Odds Ratio (OR), with 95 % confidence interval (95 % CI), of ≥1 agreement was calculated through unconditional logistic regression. Results The cohort included 767 women, 39.8 % reported medication use, and 70.5 % were dispensed at least one medication. Kappa and PABAK indicated almost perfect to substantial agreement for antihypertensive medications (Kappa 0.86, PABAK 0.99), thyroid hormones (0.88, 0.98), antiepileptic medications (1.00, 1.00), antithrombotic agents (0.70, 0.96). PABAK value was greater than Kappa for medications such as insulin (Kappa 0.50, PABAK 0.99), antihistamines for systemic use (0.50, 0.99), progestogens (0.28, 0.79), and antibiotics (0.12, 0.63). Adjusted OR was 0.48 (95 % CI 0.26; 0.90) in ex- vs. never smokers, 0.64 (0.38; 1.08) in < high school vs. university, 1.55 (1.01; 2.37) in women with comorbidities, 2.25 (1.19; 4.26) in those aged 40+ vs. 30–34 years. Gestational age matched exactly in 85.2 % and date of delivery in 99.5 %. Conclusions For selected medications used for chronic conditions, the agreement between self-reports and dispensing data was high. For medications with low to very low prevalence of use, PABAK provides a more reliable measure of agreement. Maternal reports and dispensing data are complementary to each other to increase the reliability of information on the use of medications during pregnancy. Birth certificates provide reliable data on the timing of pregnancy. FVG health databases are a valuable source of data for pregnancy research. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0745-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Federica Edith Pisa
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Via Colugna 50, 33100, Udine, Italy. .,Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
| | - Anica Casetta
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
| | - Elena Clagnan
- Direzione Centrale Salute, Integrazione Socio Sanitaria e Politiche Sociali, Regione Friuli Venezia Giulia, Udine, Italy.
| | | | - Liza Vecchi Brumatti
- Scientific Direction, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
| | - Fabio Barbone
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Via Colugna 50, 33100, Udine, Italy. .,Department of Medical and Biological Sciences, University of Udine, Udine, Italy. .,Department of Medicine, University of Trieste, Trieste, Italy.
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81
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Wyszynski DF, Shields KE. Frequency and type of medications and vaccines used during pregnancy. Obstet Med 2015; 9:21-7. [PMID: 27512486 DOI: 10.1177/1753495x15604099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Providing safe pharmacotherapy for pregnant women is challenging. Nearly all pregnant women are prescribed or inadvertently receive medication during their pregnancy. We reviewed the scientific literature to identify the specific medications and vaccines that are most often used during pregnancy and described them by category and indication. Our interest was to update the research before the implementation of the recently released FDA labeling rule for pregnancy and lactation that eliminates the use of pregnancy categories in product labels. Our results confirm that most products taken during pregnancy are over-the-counter or in the former FDA pregnancy categories A or B. However, medications taken prior to pregnancy recognition (inadvertent exposures) and those prescribed for chronic illness such as allergies, depression, and pain are of concern. A better understanding of medication and vaccine utilization during pregnancy may help clinicians reduce inadvertent first trimester exposures and improve the safe and effective treatment of pregnant women.
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Trends and Determinants of Prescription Drug Use during Pregnancy and Postpartum in British Columbia, 2002-2011: A Population-Based Cohort Study. PLoS One 2015; 10:e0128312. [PMID: 26011706 PMCID: PMC4444135 DOI: 10.1371/journal.pone.0128312] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/24/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose To describe trends, patterns, and determinants of prescription drug use during pregnancy and postpartum. Methods This is a retrospective, population-based study of all women who gave birth between January 2002 and 31 December 2011 in British Columbia, Canada. Study population consisted of 225,973 women who had 322,219 pregnancies. We examined administrative datasets containing person-specific information on filled prescriptions, hospitalizations, and medical services. Main outcome measures were filled prescriptions during pregnancy and postpartum. We used logistic regressions to examine associations between prescription drug use and maternal characteristics. Results Approximately two thirds of women filled a prescription during pregnancy, increasing from 60% in 2002 to 66% in 2011. The proportion of pregnant women using medicines in all three trimesters of pregnancy increased from 20% in 2002 to 27% in 2011. Use of four or more different types of prescription drug during at least one trimester increased from 8.4% in 2002 to 11.7% in 2011. Higher BMI, smoking during pregnancy, age under 25, carrying multiples, and being diagnosed with a chronic condition all significantly increased the odds of prescription drug use during pregnancy. Conclusions The observed increase in the number of prescriptions and number of different drugs being dispensed suggests a trend in prescribing practices with potentially important implications for mothers, their neonates, and caregivers. Monitoring of prescribing practices and further research into the safety of most commonly prescribed medications is crucial in better understanding risks and benefits to the fetus and the mother.
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Dillon P, O'Brien KK, McDonnell R, Donnelly-Swift E, Galvin R, Roche A, Cronin K, Walsh DR, Schelten R, Smith S, Fahey T. Prevalence of prescribing in pregnancy using the Irish primary care research network: a pilot study. BMC Pregnancy Childbirth 2015; 15:67. [PMID: 25884886 PMCID: PMC4389301 DOI: 10.1186/s12884-015-0489-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/24/2015] [Indexed: 11/10/2022] Open
Abstract
Background To establish the prevalence and patterns of prescribing to pregnant women in an Irish primary care setting. Methods We reviewed electronic healthcare records routinely collected in primary care, of pregnant women attending nine Dublin-based General Practices affiliated to the Irish Primary Care Research Network (IPCRN) for antenatal care between January 2007 and October 2013 (n = 2,361 pregnancies). Results Excluding folic acid, 46.8% (n = 1,104) of pregnant women were prescribed at least one medication. Amoxicillin (11.1%, n = 263) and co-amoxiclav (8.0%, n = 190) were the most commonly prescribed medication followed by topical clotrimazole (4.9%, n = 117), salbutamol inhalers (4.1%, n = 96) and paracetamol (4.0%, n = 95). General Medical Services (GMS) patients were more likely to receive a prescription than private patients (OR 2.81; 95%CI (2.28, 3.47)). We applied the US FDA pregnancy-risk categories as a proxy measure of prescribing appropriateness, with FDA Category D and X medications considered inappropriate. FDA Category D drugs were prescribed in 5.9% (n = 140) of pregnancies. FDA Category X drugs were prescribed in 4.9% (n = 116) of pregnancies but after exclusion of oral contraceptives, progestogens, infertility treatments Category X medications were prescribed in 0.6% (n = 13) of pregnancies. After the initial antenatal consultation the prescribing prevalence of FDA Category D medications reduced to 4.7% (n = 110) and Category X to 3.1% (n = 72). Conclusions The overall prevalence of prescribing to pregnant women in our cohort is low compared to studies internationally, however similar levels of prescribing for FDA Category D and X were found. Following the initial antenatal consultation levels of prescribing of the FDA Category D and X medications reduced, however there is potential to further reduce their use in early pregnancy. The IPCRN database has provided valuable information on the current practice of antenatal prescribing within this pilot group of practices however it is limited by the absence of morbidity and pregnancy outcome data.
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Affiliation(s)
- Paul Dillon
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Kirsty K O'Brien
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Ronan McDonnell
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Erica Donnelly-Swift
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Rose Galvin
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Adam Roche
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Kate Cronin
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - David R Walsh
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Rowan Schelten
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Susan Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
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84
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Abstract
Pregnant women with illness require efficacious and safe drug therapy during pregnancy; however, their treatment is often hindered by a lack of information regarding the use of medications during pregnancy. Ethical challenges are encountered in conducting drug trials in pregnant women, who are often excluded from participation due to fear of harm to the fetus. However, as the health of the fetus is ultimately affected by that of the pregnant woman, inclusion of pregnant women in studies of medications that they may require for their own benefit may also benefit the unborn child. The principle of autonomy argues for the pregnant woman being able to make an informed choice to take part in a clinical trial, and the principle of justice dictates that she not be denied the benefits of drug research.
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85
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Charlton RA, Neville AJ, Jordan S, Pierini A, Damase‐Michel C, Klungsøyr K, Andersen AN, Hansen AV, Gini R, Bos JHJ, Puccini A, Hurault‐Delarue C, Brooks CJ, Jong‐van den Berg LTW, Vries CS. Healthcare databases in Europe for studying medicine use and safety during pregnancy. Pharmacoepidemiol Drug Saf 2014; 23:586-94. [DOI: 10.1002/pds.3613] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/19/2014] [Accepted: 02/20/2014] [Indexed: 01/10/2023]
Affiliation(s)
| | - Amanda J. Neville
- IMER (Emilia‐Romagna Registry of Birth Defects) Azienda Ospedaliero‐Universitaria di Ferrara Ferrara Italy
| | - Sue Jordan
- Department of Nursing, College of Human and Health Sciences Swansea University Swansea Wales UK
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council (IFC‐CNR) Pisa Italy
| | - Christine Damase‐Michel
- Pharmacologie, Médicale, Faculté de Médecine Université de Toulouse III, INSERM UMR1027 Toulouse France
| | - Kari Klungsøyr
- Medical Birth Registry of Norway The Norwegian Institute of Public Health Oslo Norway
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
| | - Anne‐Marie Nybo Andersen
- Section of Social Medicine, Department of Public Health University of Copenhagen Copenhagen Denmark
| | | | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana Florence Italy
| | - Jens H. J. Bos
- Pharmacoepidemiology and Pharmacoeconomics Unit, Department of Pharmacy University of Groningen Groningen The Netherlands
| | - Aurora Puccini
- Drug Policy Service Emilia‐Romagna Region Health Authority Bologna Italy
| | - Caroline Hurault‐Delarue
- Pharmacologie, Médicale, Faculté de Médecine Université de Toulouse III, INSERM UMR1027 Toulouse France
| | - Caroline J. Brooks
- Institute of Life Science, College of Medicine Swansea University Swansea Wales UK
| | - Lolkje T. W. Jong‐van den Berg
- Pharmacoepidemiology and Pharmacoeconomics Unit, Department of Pharmacy University of Groningen Groningen The Netherlands
| | - Corinne S. Vries
- Department of Pharmacy and Pharmacology University of Bath Bath UK
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86
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Hämeen-Anttila K, Nordeng H, Kokki E, Jyrkkä J, Lupattelli A, Vainio K, Enlund H. Multiple information sources and consequences of conflicting information about medicine use during pregnancy: a multinational Internet-based survey. J Med Internet Res 2014; 16:e60. [PMID: 24565696 PMCID: PMC3961698 DOI: 10.2196/jmir.2939] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 01/09/2014] [Accepted: 01/12/2014] [Indexed: 01/09/2023] Open
Abstract
Background A wide variety of information sources on medicines is available for pregnant women. When using multiple information sources, there is the risk that information will vary or even conflict. Objective The objective of this multinational study was to analyze the extent to which pregnant women use multiple information sources and the consequences of conflicting information, and to investigate which maternal sociodemographic, lifestyle, and medical factors were associated with these objectives. Methods An anonymous Internet-based questionnaire was made accessible during a period of 2 months, on 1 to 4 Internet websites used by pregnant women in 5 regions (Eastern Europe, Western Europe, Northern Europe, Americas, Australia). A total of 7092 responses were obtained (n=5090 pregnant women; n=2002 women with a child younger than 25 weeks). Descriptive statistics and logistic regression analysis were used. Results Of the respondents who stated that they needed information, 16.16% (655/4054) used one information source and 83.69% (3393/4054) used multiple information sources. Of respondents who used more than one information source, 22.62% (759/3355) stated that the information was conflicted. According to multivariate logistic regression analysis, factors significantly associated with experiencing conflict in medicine information included being a mother (OR 1.32, 95% CI 1.11-1.58), having university (OR 1.33, 95% CI 1.09-1.63) or other education (OR 1.49, 95% CI 1.09-2.03), residing in Eastern Europe (OR 1.52, 95% CI 1.22-1.89) or Australia (OR 2.28, 95% CI 1.42-3.67), use of 3 (OR 1.29, 95% CI 1.04-1.60) or >4 information sources (OR 1.82, 95% CI 1.49-2.23), and having ≥2 chronic diseases (OR 1.49, 95% CI 1.18-1.89). Because of conflicting information, 43.61% (331/759) decided not to use medication during pregnancy, 30.30% (230/759) sought a new information source, 32.67% (248/759) chose to rely on one source and ignore the conflicting one, 25.03% (190/759) became anxious, and 2.64% (20/759) did nothing. Factors significantly associated with not using medication as a consequence of conflicting information were being pregnant (OR 1.75, 95% CI 1.28-2.41) or experiencing 3-4 health disorders (OR 1.99, 95% CI 1.10-3.58). Women with no chronic diseases were more likely not to take medicines than women with ≥2 chronic diseases (OR 2.22, 95% CI 1.47-3.45). Factors significantly associated with becoming anxious were >4 information sources (OR 2.67, 95% CI 1.70-4.18) and residing in Eastern Europe (OR 0.57, 95% CI 0.36-0.90). Conclusions Almost all the pregnant women used multiple information sources when seeking information on taking medicines during pregnancy and one-fifth obtained conflicting information, leading to anxiety and the decision not to use the medication. Regional, educational, and chronic disease characteristics were associated with experiencing conflicting information and influenced the decision not to use medication or increased anxiety. Accurate and uniform teratology information should be made more available to the public.
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87
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Lupattelli A, Spigset O, Twigg MJ, Zagorodnikova K, Mårdby AC, Moretti ME, Drozd M, Panchaud A, Hämeen-Anttila K, Rieutord A, Gjergja Juraski R, Odalovic M, Kennedy D, Rudolf G, Juch H, Passier A, Björnsdóttir I, Nordeng H. Medication use in pregnancy: a cross-sectional, multinational web-based study. BMJ Open 2014; 4:e004365. [PMID: 24534260 PMCID: PMC3927801 DOI: 10.1136/bmjopen-2013-004365] [Citation(s) in RCA: 275] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Intercountry comparability between studies on medication use in pregnancy is difficult due to dissimilarities in study design and methodology. This study aimed to examine patterns and factors associated with medications use in pregnancy from a multinational perspective, with emphasis on type of medication utilised and indication for use. DESIGN Cross-sectional, web-based study performed within the period from 1 October 2011 to 29 February 2012. Uniform collection of drug utilisation data was performed via an anonymous online questionnaire. SETTING Multinational study in Europe (Western, Northern and Eastern), North and South America and Australia. PARTICIPANTS Pregnant women and new mothers with children less than 1 year of age. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of and factors associated with medication use for acute/short-term illnesses, chronic/long-term disorders and over-the-counter (OTC) medication use. RESULTS The study population included 9459 women, of which 81.2% reported use of at least one medication (prescribed or OTC) during pregnancy. Overall, OTC medication use occurred in 66.9% of the pregnancies, whereas 68.4% and 17% of women reported use of at least one medication for treatment of acute/short-term illnesses and chronic/long-term disorders, respectively. The extent of self-reported medicated illnesses and types of medication used by indication varied across regions, especially in relation to urinary tract infections, depression or OTC nasal sprays. Women with higher age or lower educational level, housewives or women with an unplanned pregnancy were those most often reporting use of medication for chronic/long-term disorders. Immigrant women in Western (adjusted OR (aOR): 0.55, 95% CI 0.34 to 0.87) and Northern Europe (aOR: 0.50, 95% CI 0.31 to 0.83) were less likely to report use of medication for chronic/long-term disorders during pregnancy than non-immigrants. CONCLUSIONS In this study, the majority of women in Europe, North America, South America and Australia used at least one medication during pregnancy. There was a substantial inter-region variability in the types of medication used.
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Affiliation(s)
- A Lupattelli
- School of Pharmacy, University of Oslo, Oslo, Norway
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88
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Honein MA, Gilboa SM, Broussard CS. The need for safer medication use in pregnancy. Expert Rev Clin Pharmacol 2013; 6:453-5. [PMID: 23971869 DOI: 10.1586/17512433.2013.827401] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Margaret A Honein
- Division of Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop E-86, Atlanta, GA 30333, USA
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89
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Predictors of the use of medications before and during pregnancy. Int J Clin Pharm 2013; 35:408-16. [PMID: 23386140 DOI: 10.1007/s11096-013-9750-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Drug use in pregnancy is often reason of concern for mothers and their physicians. However, only few studies investigated predictors of drug use in pregnancy. OBJECTIVES To examine maternal characteristics as predictors of medication use in the 6 months before pregnancy and during the first 6 months of pregnancy. To examine whether prescription and over-the-counter (OTC) medication use in the 6 months before pregnancy had an impact on medication use in pregnancy. SETTING Six maternity care units and five community pharmacies. METHOD Data were collected using a specially designed self-reported questionnaire during the period March 2009-March 2010. Logistic regression was used to identify factors associated with medication use. MAIN OUTCOME MEASURE Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used as association measures. RESULTS A total of 236 women were included in the analysis. After controlling for maternal characteristics, parity of more than one was associated with lower prescription medication use in pregnancy (aOR 0.46; 95% CI 0.22-0.93), higher household income with higher OTC medication use before pregnancy (aOR 3.13; 95% CI 1.22-8.00), and miscarriage with higher C and D Food and Drug Administration (FDA) risk category medication use in pregnancy (aOR 3.65; 95% CI 1.30-10.25). Prescription medication use before pregnancy was associated with higher prescription medication use in pregnancy (aOR 2.49; 95% CI 1.12-5.52), OTC medication use before pregnancy with higher OTC medication use in pregnancy (aOR 35.95; 95% CI 7.95-162.49), and C and D FDA risk category medication use before pregnancy with the same category medication use in pregnancy (aOR 3.54; 95% CI 1.23-10.17). CONCLUSION Different maternal characteristics were shown as predictors of medication use before and during pregnancy. However, medication use before pregnancy was shown as the most important predicting factor for the medication use in pregnancy.
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90
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Hämeen-Anttila K, Jyrkkä J, Enlund H, Nordeng H, Lupattelli A, Kokki E. Medicines information needs during pregnancy: a multinational comparison. BMJ Open 2013; 3:bmjopen-2013-002594. [PMID: 23624989 PMCID: PMC3641472 DOI: 10.1136/bmjopen-2013-002594] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim was to assess the perceived needs of medicines information and information sources for pregnant women in various countries. DESIGN Cross-sectional internet-based study. SETTING Multinational. PARTICIPANTS Pregnant women and women with children less than 25 weeks. PRIMARY AND SECONDARY OUTCOME MEASURES The need for information about medicines was assessed by a question: 'Did you need information about medicines during the course of your pregnancy?' A list of commonly used sources of information was given to explore those that are used. RESULTS Altogether, 7092 eligible women responded to the survey (5090 pregnant women and 2002 women with a child less than 25 weeks). Of the respondents, 57% (n=4054, range between different countries 46-77%) indicated a need for information about medicines during their pregnancy. On average, respondents used three different information sources. The most commonly used information sources were healthcare professionals-physicians (73%), pharmacy personnel (46%) and midwifes or nurses (33%)-and the internet (60%). There were distinct differences in the information needs and information sources used in different countries. CONCLUSIONS A large proportion of pregnant women have perceived information needs about medicines during pregnancy, and they rely on healthcare professionals. The internet is also a widely used information source. Further studies are needed to evaluate the use of the internet as a medicines information source by pregnant women.
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Affiliation(s)
| | | | | | - Hedvig Nordeng
- School of Pharmacy, University of Oslo, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Esa Kokki
- Finnish Medicines Agency, Kuopio, Finland
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91
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Use of medicines with unknown fetal risk among parturient women from the 2004 Pelotas Birth Cohort (Brazil). J Pregnancy 2012; 2012:257597. [PMID: 23346403 PMCID: PMC3549362 DOI: 10.1155/2012/257597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 11/25/2012] [Accepted: 11/26/2012] [Indexed: 11/18/2022] Open
Abstract
Background. To estimate the exposure to medicines with unknown fetal risk during pregnancy and to analyze the maternal characteristics associated with it. Methods. A questionnaire was administered to 4,189 mothers of children belonging to the 2004 Pelotas (Brazil) birth cohort study about use of any medicine during gestation. We evaluated the associations between use of medicines with unknown fetal risk and the independent variables through logistic regression models. Unknown fetal risk was defined as medicines in which studies in animals have revealed adverse effects on the fetus, and no controlled studies in women, or studies in women and animals, are available. Results. Out of the 4,189 women, 52.5% used at least one medicine from unknown fetal risk. Use of these medicines was associated with white skin color, high schooling, high income, six or more antenatal care consultations, hospital admission during pregnancy, and morbidity during gestation. Conclusion. The use of unknown fetal risk medicines is high, suggesting that their use must be addressed with caution with the aim of restricting their use to cases in which the benefits are greater than the potential risks.
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92
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Thomas SHL, Yates LM. Prescribing without evidence - pregnancy. Br J Clin Pharmacol 2012; 74:691-7. [PMID: 22607226 PMCID: PMC3477338 DOI: 10.1111/j.1365-2125.2012.04332.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 05/01/2012] [Indexed: 12/01/2022] Open
Abstract
Prescribing of medicines during pregnancy is common, and for some groups of women is essential for maintaining maternal and therefore fetal health. Pregnant women and prescribers are rightly concerned, however, about the potential adverse fetal effects of medicines. These may include fetal death or stillbirth, congenital malformations, developmental impairment, neonatal effects or late carcinogenesis. It is therefore essential that the risks and benefits for mother and fetus are considered carefully before prescribing in pregnancy. This is often challenging because of the paucity of information available. To complicate the issue further, drug pharmacokinetics are commonly altered in pregnancy, potentially affecting optimal dosing as well as interpretation of plasma concentration measurements, with specific information on individual drugs seldom available. Most drugs cross the placenta, especially lipophilic drugs and those with low plasma protein binding. Active membrane transporters also have an important role in enhancing or preventing drug transfer, although this is not yet clearly understood. Animal studies have limited applicability to humans because of species-specific effects, and clinical trials in pregnancy are only undertaken in special circumstances. Prescribers therefore need to rely on observational studies of fetal outcomes following drug exposure in human pregnancy. These often involve limited numbers, and data are also subject to confounding and bias, making interpretation difficult. It therefore remains essential that appropriate mechanisms for systematic data collection, including congenital malformation registries, teratology information services, pregnancy registers and linked population registries, are maintained and enhanced to increase the amount and quality of information available.
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Affiliation(s)
- Simon H L Thomas
- UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.
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93
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A Semi-Mechanistic Metabolism Model of CYP3A Substrates in Pregnancy: Predicting Changes in Midazolam and Nifedipine Pharmacokinetics. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2012; 1:e2. [PMID: 23835882 PMCID: PMC3603475 DOI: 10.1038/psp.2012.5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physiological changes in pregnancy, including changes in body composition and metabolic enzyme activity, can alter drug pharmacokinetics. A semi-mechanistic metabolism model was developed to describe the pharmacokinetics of two cytochrome P450 3A (CYP3A) substrates, midazolam and nifedipine, in obstetrics patients. The model parameters were optimized to fit the data of oral midazolam pharmacokinetics in pregnant women, by increasing CYP3A-induced hepatic metabolism 1.6-fold in the model with no change in gut wall metabolism. Fetal metabolism had a negligible effect on maternal plasma drug concentrations. Validation of the model was performed by applying changes in volume of distribution and metabolism, consistent with those observed for midazolam, to the pharmacokinetics parameters of immediate-release nifedipine in healthy volunteers. The predicted steady-state areas under the concentration–time curve (AUCs) for nifedipine were within 15% of the data observed in pregnant women undergoing treatment for preterm labor. This model predicts the pharmacokinetics of two CYP3A substrates in pregnancy, and may be applicable to other CYP3A substrates as well.
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94
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Aleksunes LM, Yeager RL, Wen X, Cui JY, Klaassen CD. Repression of hepatobiliary transporters and differential regulation of classic and alternative bile acid pathways in mice during pregnancy. Toxicol Sci 2012; 130:257-68. [PMID: 22903823 DOI: 10.1093/toxsci/kfs248] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
During pregnancy, proper hepatobiliary transport and bile acid synthesis protect the liver from cholestatic injury and regulate the maternal and fetal exposure to bile acids, drugs, and environmental chemicals. The objective of this study was to determine the temporal messenger RNA (mRNA) and protein profiles of uptake and efflux transporters as well as bile acid synthetic and conjugating enzymes in livers from virgin and pregnant mice on gestational days (GD) 7, 11, 14, and 17 and postnatal days (PND) 1, 15, and 30. Compared with virgins, the mRNAs of most transporters were reduced approximately 50% in pregnant dams between GD11 and 17. Western blot and immunofluorescence staining confirmed the downregulation of Mrp3, 6, Bsep, and Ntcp proteins. One day after parturition, the mRNAs of many uptake and efflux hepatobiliary transporters remained low in pregnant mice. By PND30, the mRNAs of all transporters returned to virgin levels. mRNAs of the bile acid synthetic enzymes in the classic pathway, Cyp7a1 and 8b1, increased in pregnant mice, whereas mRNA and protein expression of enzymes in the alternative pathway of bile acid synthesis (Cyp27a1 and 39a1) and conjugating enzymes (Bal and Baat) decreased. Profiles of transporter and bile acid metabolism genes likely result from coordinated downregulation of transcription factor mRNA (CAR, LXR, PXR, PPARα, FXR) in pregnant mice on GD14 and 17. In conclusion, pregnancy caused a global downregulation of most hepatic transporters, which began as early as GD7 for some genes and was maximal by GD14 and 17, and was inversely related to increasing concentrations of circulating 17β-estradiol and progesterone as pregnancy progressed.
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Affiliation(s)
- Lauren M Aleksunes
- Department of Pharmacology, Toxicology, and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas 66160, USA
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95
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Drug use before and during pregnancy in Serbia. Int J Clin Pharm 2012; 34:719-27. [PMID: 22744842 DOI: 10.1007/s11096-012-9665-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 06/18/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Observation of drug use patterns during pregnancy is necessary for the recognition of potential bad practices and improvement of safe drug use in pregnancy. OBJECTIVE To investigate prescription and over the counter drug use among Serbian women in the 6 months before pregnancy and in the first 6 months of pregnancy, and to evaluate the drugs used according to the risk to a fetus. Setting Six maternity care units and five community pharmacies. METHOD A multi-center study was performed in Serbia during the period from March 2009-March 2010. A self-reporting questionnaire was used as a data source. Food and Drug Administration (FDA) risk classification system was used to determine the risk of used drugs for the fetus. Differences between subgroups were assessed using McNemar's test on paired proportions. Main outcome measure Proportion of women exposed to drugs or class of drugs. RESULTS The overall drug exposure was higher in pregnancy (34.7 %) than before pregnancy (29.9 %), p > 0.05, in the cohort of 311 pregnant women. A significantly greater prescription drug use, 19.0 versus 27.3 % of women, p < 0.05, and less selfmedication with over the counter drugs in pregnancy, 15.1 versus 8.7 %, p < 0.05, were observed. Commonly used drugs were musculoskeletal drugs, analgesics/antipyretics and respiratory system drugs before pregnancy (13.8, 12.5, and 6.4 % of women, respectively), and progestogens, analgesics/antipyretics, and antibiotics for the systemic use in pregnancy (9.0, 7.7, and 7.4 %, respectively). A greater exposure to drugs belonging to the FDA risk category A (3.9 vs. 60.8 %, p < 0.05), B (18.0 vs. 19.6 %, p > 0.05), C (10.0 vs. 10.3 %, p > 0.05) and D (2.9 vs. 10.9 %, p < 0.05), as well as less exposure to drugs belonging to category X (0.3 vs. 0 %, p > 0.05) were observed in pregnancy. Folic acid was used by 60.8 % of women in pregnancy, and by only 3.9 % before pregnancy. CONCLUSION Besides higher overall drug use in pregnancy than before pregnancy, particularly the use of progestogens, and, subsequently, D category drugs, less selfmedication with over the counter drugs was observed in pregnancy. Insufficient use of folic acid before pregnancy requires public health service activities.
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