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Lovegrove E, Maidwell-Smith A, Stuart B, Santer M. Selective serotonin reuptake inhibitors (SSRIs) in women of reproductive age: a systematic review of local formularies. BJGP Open 2024:BJGPO.2023.0255. [PMID: 38272494 DOI: 10.3399/bjgpo.2023.0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Depression is the second most common chronic condition affecting women of reproductive age; 23.4% of women enter pregnancy with depression and use of selective serotonin reuptake inhibitors (SSRIs) in pregnancy is often necessary for maternal wellbeing. However, SSRI use during pregnancy can cause congenital malformations, postpartum haemorrhage (PPH), and persistent pulmonary hypertension of the newborn (PPHN). In UK primary care, prescribing formularies are one medium by which prescribers are provided with local medicines advice. AIM To review all local prescribing formularies with respect to prescribing SSRIs in women of reproductive age, during pregnancy, and during breastfeeding. DESIGN & SETTING A systematic review of prescribing formularies in England and Wales. METHOD A systematic keyword search of all clinical commissioning group and Integrated Care Board websites in England and Local Health Board websites in Wales was undertaken between December 2021-22 to identify prescribing formularies. Data were extracted on prescribing guidance for SSRIs. RESULTS Seventy-four prescribing formularies were reviewed. Of these, 14.9% (n = 11/74) provided links to the Medicines and Healthcare products Regulatory Agency guidance on congenital abnormalities associated with SSRIs, 28.4% (n = 21/74) provided links to guidance on PPH risk, and 1.4% (n = 1/74) provided links to guidance on PPHN. Specific local guidance was given on SSRI prescribing for women of reproductive age, during pregnancy, and during breastfeeding in 12.2% (n = 9/74), 23.0% (n = 17/74), and 21.6% (n = 16/74) of formularies, respectively. CONCLUSION Our results suggest that prescribers may be poorly informed by local formularies about the risks of SSRI use around pregnancy. This could place babies at increased risk of unintentional SSRI exposure.
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Affiliation(s)
| | | | - Beth Stuart
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton, UK
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Judistiani RTD, Pratiwi AE, Wahyudi K, Gunawan A, Rahmawati A, Ruslami R. Medication Use and Associated Factors Among Indonesian Pregnant Women: A Cross-Sectional Study. J Multidiscip Healthc 2023; 16:4173-4179. [PMID: 38146360 PMCID: PMC10749785 DOI: 10.2147/jmdh.s440426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023] Open
Abstract
Purpose Medication use during pregnancy should be considered carefully due to its potential harm to the fetus. Data on prescribed medication and self-medication among Indonesian pregnant women is lacking. This study aimed to assess the prevalence and factors related to medication use among pregnant women attending antenatal care services at community health posts in Soreang, a suburban area in Indonesia. Patients and Methods A cross-sectional community-based study was conducted. Data on medication use, excluding supplements, were collected. Medication was categorized using the former United States Food and Drug Administration (US FDA) pregnancy risk classification system. Proportions of pregnant women using prescribed medication and self-medication during pregnancy and associated factors were calculated. Results A total of 439 pregnant women were enrolled. There were 155 (35.5%) subjects who used at least one medication during pregnancy. These subjects had medical problems as the reasons for medication use. Among medication users, prescribed medication and self-medication were demonstrated in 138 (89.0%) and 17 (11.0%) pregnant women, respectively. There was a pregnant woman who was exposed to category D medication. Self-medication among pregnant women was less likely when health insurance was available (adjusted OR = 0.11, 95% CI: 0.027-0.413, P = 0.001). Conclusion The prevalence of medication use among Indonesian pregnant women is high. The presence of health insurance was protective against self-medication among pregnant women. Safe and effective practices in prescribing have to be ensured for pregnant women.
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Affiliation(s)
- Raden Tina Dewi Judistiani
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Centre for Clinical Infection Studies, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Aprilya Eka Pratiwi
- Magister in Epidemiology Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Kurnia Wahyudi
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Agnesya Gunawan
- Centre for Clinical Infection Studies, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Anita Rahmawati
- Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Rovina Ruslami
- Centre for Clinical Infection Studies, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Anand A, Phillips K, Subramanian A, Lee SI, Wang Z, McCowan R, Agrawal U, Fagbamigbe AF, Nelson-Piercy C, Brocklehurst P, Damase-Michel C, Loane M, Nirantharakumar K, Azcoaga-Lorenzo A. Prevalence of polypharmacy in pregnancy: a systematic review. BMJ Open 2023; 13:e067585. [PMID: 36878655 PMCID: PMC9990613 DOI: 10.1136/bmjopen-2022-067585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/22/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES The use of medications among pregnant women has been rising over the past few decades but the reporting of polypharmacy has been sporadic. The objective of this review is to identify literature reporting the prevalence of polypharmacy among pregnant women, the prevalence of multimorbidity in women taking multiple medications in pregnancy and associated effects on maternal and offspring outcomes. DESIGN MEDLINE and Embase were searched from their inception to 14 September 2021 for interventional trials, observational studies and systematic reviews reporting on the prevalence of polypharmacy or the use of multiple medications in pregnancy were included.Data on prevalence of polypharmacy, prevalence of multimorbidity, combinations of medications and pregnancy and offspring outcomes were extracted. A descriptive analysis was performed. RESULTS Fourteen studies met the review criteria. The prevalence of women being prescribed two or more medications during pregnancy ranged from 4.9% (4.3%-5.5%) to 62.4% (61.3%-63.5%), with a median of 22.5%. For the first trimester, prevalence ranged from 4.9% (4.7%-5.14%) to 33.7% (32.2%-35.1%). No study reported on the prevalence of multimorbidity, or associated pregnancy outcomes in women exposed to polypharmacy. CONCLUSION There is a significant burden of polypharmacy among pregnant women. There is a need for evidence on the combinations of medications prescribed in pregnancy, how this specifically affects women with multiple long-term conditions and the associated benefits and harms. TWEETABLE ABSTRACT Our systematic review shows significant burden of polypharmacy in pregnancy but outcomes for women and offspring are unknown. PROSPERO REGISTRATION NUMBER CRD42021223966.
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Affiliation(s)
- Astha Anand
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zhaonan Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Utkarsh Agrawal
- Division of Population and Behavioural Sciences, University of Saint Andrews School of Medicine, St. Andrews, UK
| | - Adeniyi Frances Fagbamigbe
- Division of Population and Behavioural Sciences, University of Saint Andrews School of Medicine, St. Andrews, UK
- Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Maria Loane
- Institute of Nursing and Health Research, University of Ulster, Belfast, UK
| | | | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, University of Saint Andrews School of Medicine, St. Andrews, UK
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Schrager NL, Parker SE, Werler MM. The association of nausea and vomiting of pregnancy, its treatments, and select birth defects: Findings from the National Birth Defect Prevention Study. Birth Defects Res 2023; 115:275-289. [PMID: 36168701 DOI: 10.1002/bdr2.2096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nausea and vomiting of pregnancy (NVP) occurs in approximately 70% of pregnant people. Treatments include pharmacologic and herbal/natural products. Research on the associations between NVP and its treatments and birth defects is limited. METHODS We used data from the case-control National Birth Defects Prevention Study (1997-2011) to examine whether first-trimester NVP or its specific treatments were associated with 37 major birth defects. Odds ratios (aOR) and 95% confidence intervals (CIs) were adjusted for sociodemographic and reproductive factors. RESULTS Mothers of 66.6% of 28,628 cases and 69.9% of 11,083 controls reported first-trimester NVP. Compared to no NVP, mothers with NVP had ≥10% reduction in risk of cardiac and noncardiac defects overall, and of 18 specific defects. Over-the-counter antiemetic use, compared to untreated NVP, was associated with ≥10% increase in risk for nine defect groups (heterotaxy, hypoplastic left heart syndrome [HLHS], aortic stenosis, cataracts, anophthalmos/microphthalmos, biliary atresia, transverse limb deficiency, omphalocele, and gastroschisis), whereas use of prescription antiemetics increased risk ≥10% for seven defect groups (tetralogy of Fallot, HLHS, spina bifida, anopthlamos/microphthalmos, cleft palate, craniosynostosis, and diaphragmatic hernia). We observed increased risks for promethazine and tetralogy of Fallot (aOR: 1.49, 95% CI: 1.05-2.10), promethazine and craniosynostosis (1.44, 1.08-1.92), ondansetron and cleft palate (1.66, 1.18-2.31), pyridoxine and heterotaxy (3.91, 1.49-10.27), and pyridoxine and cataracts (2.57, 1.12-5.88). CONCLUSIONS NVP does not increase risks of birth defects. Our findings that some treatments for NVP increase risk of specific birth defects should be investigated further before clinical recommendations are made.
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Affiliation(s)
- Nina L Schrager
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Adeoye I, Etuk V. Prevalence, predictors and pregnancy outcomes of unprescribed and herbal medicine use in Ibadan, Nigeria. BMC Complement Med Ther 2023; 23:17. [PMID: 36670404 PMCID: PMC9854176 DOI: 10.1186/s12906-023-03838-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Unprescribed and herbal medicines use among pregnant women is a public health concern in low and middle-income countries because of the potential teratogenic effects, insufficient safety and weak drug regulatory systems. Unprescribed and herbal medicines are common among pregnant women in Nigeria, and only a few researchers have documented the prevalence and the risk factors. However, evidence on the associated pregnancy outcomes is still lacking. We assessed the prevalence, predictors and pregnancy outcomes of unprescribed and herbal medicines use among pregnant women in Ibadan, Nigeria. METHODS This study was a component of the Ibadan Pregnancy Cohort Study, a prospective cohort study, among pregnant women in Ibadan, Nigeria, who were enrolled at ≤ 20 weeks gestation at their first antenatal visit and followed up till delivery. In all, 571 women participated in the maternal drug use assessment during the third trimester using a pretested interviewer-administered questionnaire. The primary outcomes were unprescribed and herbal medicines use and pregnancy outcomes, secondary outcomes, were abstracted from medical records. The predictors assessed included sociodemographic, obstetric, antenatal care utilization, and lifestyle characteristics. Bi-variate logistic and Poisson regression analyses were used to evaluate the predictors and relative risk for the pregnancy outcomes of unprescribed and herbal medicines at 5% significance. RESULTS The prevalence of unprescribed and herbal medicine use was 31.9% and 21.7%, respectively. On bivariate analysis, the significant predictors of unprescribed medicine (which were protective) were tertiary education, increasing income, adequate antenatal care (≥ 4 visits), and at least two doses of sulfadoxine-pyrimethamine. However, high parity and having an antenatal admission increased the risk. However, after adjusting for confounders, the significant factors associated with unprescribed medicines were; tertiary education (AOR) = 0.23; 95% CI: (0.06 - 0.95); p-value: 0.043] and obtaining at least two doses of sulfadoxine-pyrimethamine [AOR = 0.33; 95% CI: (0.29 - 3.60); p-value: 0.048]. For herbal medicines, the predictors were similar to unprescribed drugs. However, after adjusting for confounders, none was significant for herbal medicines. Unprescribed and herbal medicines were not significantly associated with pregnancy outcomes. CONCLUSIONS Unprescribed and herbal medicines use were common among pregnant women in Ibadan, Nigeria, particularly among women with low economic status and those with poor utilization of antenatal care services. These significant predictors can be targeted for public health intervention. Specifically, health education that discourages the use of unprescribed and herbal medications to pregnant women during antenatal care.
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Affiliation(s)
- Ikeola Adeoye
- grid.9582.60000 0004 1794 5983Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria ,Consortium of Advanced Research for Africa (CARTA), Nairobi, Kenya
| | - Victoria Etuk
- grid.9582.60000 0004 1794 5983Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Subramanian A, Azcoaga-Lorenzo A, Anand A, Phillips K, Lee SI, Cockburn N, Fagbamigbe AF, Damase-Michel C, Yau C, McCowan C, O'Reilly D, Santorelli G, Hope H, Kennedy JI, Abel KM, Eastwood KA, Locock L, Black M, Loane M, Moss N, Plachcinski R, Thangaratinam S, Brophy S, Agrawal U, Vowles Z, Brocklehurst P, Dolk H, Nelson-Piercy C, Nirantharakumar K. Polypharmacy during pregnancy and associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019. BMC Med 2023; 21:21. [PMID: 36647047 PMCID: PMC9843951 DOI: 10.1186/s12916-022-02722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The number of medications prescribed during pregnancy has increased over the past few decades. Few studies have described the prevalence of multiple medication use among pregnant women. This study aims to describe the overall prevalence over the last two decades among all pregnant women and those with multimorbidity and to identify risk factors for polypharmacy in pregnancy. METHODS A retrospective cohort study was conducted between 2000 and 2019 using the Clinical Practice Research Datalink (CPRD) pregnancy register. Prescription records for 577 medication categories were obtained. Prevalence estimates for polypharmacy (ranging from 2+ to 11+ medications) were presented along with the medications commonly prescribed individually and in pairs during the first trimester and the entire pregnancy period. Logistic regression models were performed to identify risk factors for polypharmacy. RESULTS During the first trimester (812,354 pregnancies), the prevalence of polypharmacy ranged from 24.6% (2+ medications) to 0.1% (11+ medications). During the entire pregnancy period (774,247 pregnancies), the prevalence ranged from 58.7 to 1.4%. Broad-spectrum penicillin (6.6%), compound analgesics (4.5%) and treatment of candidiasis (4.3%) were commonly prescribed. Pairs of medication prescribed to manage different long-term conditions commonly included selective beta 2 agonists or selective serotonin re-uptake inhibitors (SSRIs). Risk factors for being prescribed 2+ medications during the first trimester of pregnancy include being overweight or obese [aOR: 1.16 (1.14-1.18) and 1.55 (1.53-1.57)], belonging to an ethnic minority group [aOR: 2.40 (2.33-2.47), 1.71 (1.65-1.76), 1.41 (1.35-1.47) and 1.39 (1.30-1.49) among women from South Asian, Black, other and mixed ethnicities compared to white women] and smoking or previously smoking [aOR: 1.19 (1.18-1.20) and 1.05 (1.03-1.06)]. Higher and lower age, higher gravidity, increasing number of comorbidities and increasing level of deprivation were also associated with increased odds of polypharmacy. CONCLUSIONS The prevalence of polypharmacy during pregnancy has increased over the past two decades and is particularly high in younger and older women; women with high BMI, smokers and ex-smokers; and women with multimorbidity, higher gravidity and higher levels of deprivation. Well-conducted pharmaco-epidemiological research is needed to understand the effects of multiple medication use on the developing foetus.
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Affiliation(s)
- Anuradhaa Subramanian
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Astha Anand
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Neil Cockburn
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Adeniyi Francis Fagbamigbe
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Christine Damase-Michel
- Medical and Clinical Pharmacology, School of Medicine, Université Toulouse III, Toulouse, France
- INSERM, Center for Epidemiology and Research in Population Health (CERPOP), Toulouse, CIC 1436, France
| | - Christopher Yau
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Health Data Research UK, Oxford, UK
| | - Colin McCowan
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | | | - Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | | | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Louise Locock
- Health Services Research Unit, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Mairead Black
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Maria Loane
- Centre for Maternal, Fetal and Infant Research, The Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - Ngawai Moss
- Patient and Public Representative, London, UK
| | | | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Sinead Brophy
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Utkarsh Agrawal
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Zoe Vowles
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, The Institute of Nursing and Health Research, Ulster University, Coleraine, UK
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Casey E, Velez MP, Gaudet L, Brogly SB. The use, perceptions and knowledge of safety of over-the-counter medications during pregnancy in a Canadian population. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231199394. [PMID: 37750453 PMCID: PMC10521281 DOI: 10.1177/17455057231199394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 07/28/2023] [Accepted: 08/18/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The prevalence of prenatal over-the-counter medication use in Canadian women is unknown. METHODS A cross-sectional study of prenatal over-the-counter medication use and safety knowledge was conducted among pregnant and post-partum women attending an academic hospital obstetrics clinic. RESULTS Seventy-two women participated; 90.3% were Caucasian, 69.4% had a college/university degree, and 61.1% lived in an urban area. Of the 72 women, 87.5% used over-the-counter medications prenatally, first (55.6%), second (65.3%), and third (47.2%) trimesters, with prenatal acetaminophen use most common (72.2%). Women who used over-the-counter medications 1-0onths before conception were more likely to use over-the-counter medications during pregnancy, and 18% of women initiated over-the-counter medications in pregnancy. Women self-reported a medium level of over-the-counter medication safety knowledge (73.6%) and responded that not all over-the-counter medications are safe during pregnancy (95.8%). CONCLUSION Despite limited safety profiles of some over-the-counter medications, pre-conception and prenatal over-the-counter medication use was high. Further research on the risk of over-the-counter medications and combinations in pregnancy is needed to help women to make safe choices during pregnancy.
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Affiliation(s)
- E Casey
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - MP Velez
- Department of Obstetrics and Gynaecology, Queen’s University, Kingston, ON, Canada
| | - L Gaudet
- Department of Obstetrics and Gynaecology, Queen’s University, Kingston, ON, Canada
| | - SB Brogly
- Department of Surgery, Queen’s University, Kingston, ON, Canada
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Danevska M, Pechijareva Sadikarijo I, Sekovska J, Naumovska Z. Pharmacovigilance system role in safe use of medicines in pregnancy and breastfeeding. MAKEDONSKO FARMACEVTSKI BILTEN 2022. [DOI: 10.33320/maced.pharm.bull.2022.68.03.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Marijana Danevska
- Agency for drugs and medical devices, Blvd. Ss. Cyril and Methodius 54, 1000 Skopje, R.N. Macedonia
| | | | | | - Zorica Naumovska
- Faculty of Pharmacy, University “Ss Cyril and Methodius”, Mother Theresa 47, 1000 Skopje, Republic of N. Macedonia
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Given J, Casson K, Dolk H, Loane M. Sociodemographic variation in prescriptions dispensed in early pregnancy in Northern Ireland 2010–2016. PLoS One 2022; 17:e0267710. [PMID: 35994459 PMCID: PMC9394805 DOI: 10.1371/journal.pone.0267710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/14/2022] [Indexed: 11/21/2022] Open
Abstract
Aim To establish the prevalence of prescriptions dispensed in early pregnancy by maternal age and area deprivation, for women who gave birth in Northern Ireland (NI) 2011–2016. Study design Population-based linked cohort study. Methods The NI Maternity System (NIMATS) database was used to identify all births to resident mothers in NI between 2011 and 2016. Prescriptions dispensed between the last menstrual period (LMP) and the first antenatal care visit (mean 10.7 weeks) (2010–2016) were extracted from the Enhanced Prescribing Database (EPD) which records all prescriptions dispensed by pharmacists in NI. EPD data were linked to NIMATS using the mother’s Health and Care Number. Maternal deprivation based on the NI Multiple Deprivation Measure 2017 was linked using the mother’s postcode. Results The cohort included 139,687 pregnancies resulting in live or stillbirths to 106,206 women. A medication was dispensed in 63.5% of pregnancies, and in 48.7% of pregnancies excluding supplements (vitamins, iron, and folic acid). Folic acid was the most commonly dispensed medication (33.1%). Excluding supplements, the mean number of medications was 1.1, with 4.2% having ≥5 medications. The most common non-supplement medications were antibiotics (13.1%), antiemetics (8.7%), analgesics (6.9%), hormonal medications (6.9%) and antidepressants (6.1%). Younger women (<20 years) had more antibiotics while older women (40+ years) had more antidepressants, cardiovascular, antihypertensives, anticoagulant medications and thyroxine. The proportion of women living in the most deprived areas with prescriptions for antidepressants, sedatives, tranquilisers, analgesics, and anti-epileptic medications was double the proportion of women with these medications in the least deprived areas. Conclusion Half of all pregnant women in NI were dispensed a non-supplement medication between LMP and the first antenatal care visit. Younger and older mothers and those living in the most deprived areas were more likely to have medications dispensed. More antidepressants were dispensed in areas of social deprivation.
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Affiliation(s)
- Joanne Given
- Faculty of Life & Health Sciences, Ulster University, Belfast, Northern Ireland, United Kingdom
| | - Karen Casson
- Faculty of Life & Health Sciences, Ulster University, Belfast, Northern Ireland, United Kingdom
| | - Helen Dolk
- Faculty of Life & Health Sciences, Ulster University, Belfast, Northern Ireland, United Kingdom
| | - Maria Loane
- Faculty of Life & Health Sciences, Ulster University, Belfast, Northern Ireland, United Kingdom
- * E-mail:
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Ceulemans M, Foulon V, Panchaud A, Winterfeld U, Pomar L, Lambelet V, Cleary B, O’Shaughnessy F, Passier A, Richardson JL, Nordeng H. Self-Reported Medication Use among Pregnant and Breastfeeding Women during the COVID-19 Pandemic: A Cross-Sectional Study in Five European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031389. [PMID: 35162405 PMCID: PMC8835534 DOI: 10.3390/ijerph19031389] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023]
Abstract
Insight into the epidemiology of perinatal medication use during the COVID-19 pandemic is scarce. Therefore, a cross-sectional study using an anonymous web survey was performed in Ireland, Norway, Switzerland, The Netherlands, and United Kingdom (UK) to investigate the prevalence and type of medications used by pregnant and breast-feeding women during the first pandemic wave. Factors associated with medication use were estimated by logistic regression. In total, 8378 women participated (i.e., 3666 pregnant and 4712 breastfeeding women). Most responses were collected in Norway (34%) and The Netherlands (28%), followed by Switzerland (19%), Ireland (17%) and UK (2%). Participants were more often professionally active and more often had a higher educational level compared to the general birthing population in each country. Overall, approximately 60% of women reported having used at least 1 medication in the preceding 3 months. Daily and occasional use was reported by 34% and 42% of pregnant and 29% and 44% of breastfeeding women. The most prevalent ATC (Anatomical Therapeutic Chemical) categories were the nervous system, the respiratory system, the alimentary tract/metabolism, and the musculo-skeletal system. Paracetamol, ibuprofen, antacids, and cetirizine were the most frequently used medications. The rate of antibacterial use was lower than previously reported. Having a chronic illness, country, maternal age, SARS-CoV-2 testing, professional status and time since delivery were associated with medication use. In conclusion, perinatal medication use was highly prevalent during the first pandemic wave, underlining the importance of maintaining counseling efforts on medication use, even in times of disrupted healthcare services and/or limited resources.
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Affiliation(s)
- Michael Ceulemans
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium;
- Teratology Information Service, Pharmacovigilance Centre Lareb, 5237 MH Hertogenbosch, The Netherlands;
- L-C&Y, KU Leuven Child & Youth Institute, 3000 Leuven, Belgium
- Correspondence: ; Tel.: +32-(16)-377227
| | - Veerle Foulon
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium;
| | - Alice Panchaud
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - Ursula Winterfeld
- Swiss Teratogen Information Service, Clinical Pharmacology Service, Lausanne University Hospital, 1011 Lausanne, Switzerland;
| | - Léo Pomar
- Materno-Fetal and Obstetrics Research Unit, Lausanne University Hospital, 1011 Lausanne, Switzerland; (L.P.); (V.L.)
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, 1011 Lausanne, Switzerland
| | - Valentine Lambelet
- Materno-Fetal and Obstetrics Research Unit, Lausanne University Hospital, 1011 Lausanne, Switzerland; (L.P.); (V.L.)
| | - Brian Cleary
- Rotunda Hospital, D01 P5W9 Dublin, Ireland; (B.C.); (F.O.)
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, D02 VN15 Dublin, Ireland
| | - Fergal O’Shaughnessy
- Rotunda Hospital, D01 P5W9 Dublin, Ireland; (B.C.); (F.O.)
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, D02 VN15 Dublin, Ireland
| | - Anneke Passier
- Teratology Information Service, Pharmacovigilance Centre Lareb, 5237 MH Hertogenbosch, The Netherlands;
| | - Jonathan Luke Richardson
- UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE2 4AB, UK;
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, 0316 Oslo, Norway;
- Department of Child Health and Development, Norwegian Institute of Public Health, 0213 Oslo, Norway
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11
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Pang YY, Ma CL. Real-world pharmacological treatment patterns of patients with threatened miscarriage in China from 2014 to 2020: A cross-sectional analysis. J Clin Pharm Ther 2021; 47:228-236. [PMID: 34704273 DOI: 10.1111/jcpt.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/13/2021] [Accepted: 09/22/2021] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Approximately half of the patients with threatened miscarriage suffer an abortion, and consistent medication therapy to prevent threatened miscarriage is lacking. Our goal was to investigate the real-world pharmacological treatment patterns of patients with threatened miscarriage in China, with a focus on the trend and rationality of progestogen use over the last 7 years. METHODS We performed a cross-sectional analysis of data from the Hospital Prescription Analysis Cooperation Project that is overseen by the Chinese Pharmaceutical Association. Information was extracted from prescriptions of outpatients with threatened miscarriage between January 2014 and December 2020. We quantified the types of medications using the first level anatomical therapeutic chemical (ATC) classification code and the frequency of use of medicines classified as category X by the United States Food and Drug Administration (FDA). We also calculated the prevalence of the most frequently used progestogens by assessing prescription rates, determined the sum of the defined daily doses (DDDs) and defined daily cost (DDC) and evaluated the rationality of progestogens according to drug labels and guidelines. RESULTS AND DISCUSSION Of the 91,464 patients included in this study, 69.4% were from the eastern region, 92.5% were from tertiary hospitals, and 72.9% were between 25 and 34 years old. The average number of medications per patient was 1.4. The following types of medicines were the most prevalent: "genitourinary system and sex hormones" (90.7%), "alimentary tract and metabolism" (10.8%) and "blood and blood-forming organs" (9.9%). Progestogens were prescribed for 81,080 patients (88.6%), among which oral progesterone (39.7%) was the most commonly used, followed by oral dydrogesterone (34.4%), progesterone injection (26.0%), oral allylestrenol (0.7%) and progesterone gel (0.4%). In other words, 10,991 (12.0%) patients used more than one progestogen, and the top three combinations were oral dydrogesterone plus progesterone injection (5.6%), oral progesterone plus progesterone injection (4.7%) and oral dydrogesterone plus oral progesterone (1.1%). The prescription rate of dydrogesterone increased gradually, whereas that of progesterone, especially progesterone injection, obviously decreased. Among 34,760 prescriptions of progestogens with complete usage information, the primary errors of progestogen use were "low frequency" (18.4%), "high single dose" (15.9%) and "low single dose" (11.3%). In addition, 137 prescriptions were identified with drug-progestogen interactions, and 61 were identified with contraindications for progestogens. A total of 4.5% of prescriptions included FDA category X medicines. WHAT IS NEW AND CONCLUSION Our findings are the first to provide information on medication use in patients with threatened miscarriage over the last seven years in China. Medicines targeting the "genitourinary system and sex hormones," especially progestogens, were the most commonly prescribed medications, among which dydrogesterone was the most prevalent. However, it is remarkable that the use of progestogens for the treatment of threatened abortion is still controversial; thus, high-quality large sample studies are still required, especially among Chinese patients. Since usage errors in progestogen records and exposure to category X medicines were common, more efforts are needed to guarantee the safety and rationality of medicines used in pregnant women.
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Affiliation(s)
- Yan-Yu Pang
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China.,Department of Pharmacy, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chun-Lai Ma
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
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12
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Stoup T, Chenivesse C. [Management of asthma during pregnancy]. Rev Mal Respir 2021; 38:626-637. [PMID: 34052060 DOI: 10.1016/j.rmr.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Abstract
Asthma is the most common chronic condition in pregnant women. The risks of complications associated with asthma for the mother, the foetus and the pregnancy are mainly due to uncontrolled asthma and the occurrence of exacerbations. These events are promoted by the patient's difficulty in complying with treatment or by prescription insufficiency for an unjustified fear of teratogenicity. The challenge of the management of asthma during pregnancy is to ensure optimal maternal asthma control in order to prevent foetal hypoxia and thus, reduce the risk of complications. Preventing the occurrence of asthma symptoms and exacerbations, ensuring optimal lung function and managing the risk factors of poor asthma outcomes and comorbidities are the principles necessary to achieve this goal. Because of the low or non-existent risks of the main treatments of asthma for the foetus and the mother, it is widely recommended that all therapies initiated before conception are continued, in particular inhaled corticosteroids, and to adjust the dosage to the minimum effective dose. During the preconception period and throughout pregnancy, coordination of the different healthcare professionals (general practitioner, respiratory specialist and gynecologist) is essential, with the mother-to-be playing a central role in the management of her asthma.
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Affiliation(s)
- T Stoup
- CHU Lille, université Lille, service de pneumologie et immuno-allergologie, centre de référence constitutif pour les maladies pulmonaires rares, 59000 Lille, France
| | - C Chenivesse
- CHU Lille, université Lille, CNRS, Inserm, institut Pasteur de Lille, service de pneumologie et immuno-allergologie, centre de référence constitutif pour les maladies pulmonaires rares, U1019, UMR 9017, Center for Infection and Immunity of Lille (CIIL), CRISALIS, F-CRIN Inserm network, 59000 Lille, France.
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13
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Issa S, Longo C, Forget A, Blais L. Association between the timing of asthma diagnosis and medication use during pregnancy. Pharmacotherapy 2021; 41:342-349. [PMID: 33555035 DOI: 10.1002/phar.2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/14/2020] [Accepted: 01/22/2021] [Indexed: 11/12/2022]
Abstract
STUDY OBJECTIVE To assess whether asthma medication use during pregnancy differs in women newly diagnosed with asthma early in pregnancy (first 19 weeks of pregnancy) compared to those newly diagnosed up to 2 years pre-pregnancy. DESIGN A retrospective population-based cohort study. DATA SOURCE To conduct this study, we used the Quebec Asthma and Pregnancy Database (QAPD) constructed by linking two administrative health databases from the province of Quebec (Canada): the Régie de l'Assurance Maladie du Québec and Maintenance et Exploitation des Données pour l'Étude de la Clientèle Hospitalière databases. PATIENTS A cohort comprising pregnant women newly diagnosed with asthma at any time in the 2 years prior to pregnancy or during the first 19 weeks of pregnancy was selected from the QAPD. MEASUREMENTS AND MAIN RESULTS We assessed the number of filled prescriptions of inhaled corticosteroids (ICS), ICS/long-acting β2 agonists (LABA), and short-acting β2 agonists (SABA), as well as the number of days' supply of oral corticosteroid (OCS) from the 20th week of pregnancy until delivery. Poisson regression was used to compare the rates of asthma medication use in women diagnosed pre-pregnancy versus early in pregnancy. The cohort included 1731 women newly diagnosed with asthma pre-pregnancy and 359 women newly diagnosed with asthma early in pregnancy. Women diagnosed early in pregnancy were more likely to use ICS (adjusted rate ratio: 1.9, 95% confidence interval (CI): 1.6-2.3) and SABA (adjusted rate ratio: 2.0, 95% CI: 1.7-2.4) from the 20th week of pregnancy until delivery than those newly diagnosed pre-pregnancy. No significant differences were observed in the use of ICS/LABA [adjusted rate ratio: 0.9, 95% CI: 0.7-1.3] and OCS [adjusted rate ratio: 0.8, 95% CI: 0.6-1.2]. CONCLUSION The higher use of ICS and SABA observed in women newly diagnosed with asthma early in pregnancy may suggest a more persistent asthma phenotype caused by pregnancy-triggered hormonal changes.
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Affiliation(s)
- Simone Issa
- Faculty of Pharmacy, Université de Montréal, Montréal, Quebec, Canada.,Research Center, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Quebec, Canada
| | - Cristina Longo
- Faculty of Pharmacy, Université de Montréal, Montréal, Quebec, Canada
| | - Amélie Forget
- Faculty of Pharmacy, Université de Montréal, Montréal, Quebec, Canada.,Research Center, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Quebec, Canada
| | - Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montréal, Quebec, Canada.,Research Center, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Quebec, Canada.,Endowment Pharmaceutical Chair AstraZeneca in Respiratory Health, Montreal, Quebec, Canada
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14
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Meyer A, Fermaut M, Drouin J, Carbonnel F, Weill A. Drug use for gastrointestinal symptoms during pregnancy: A French nationwide study 2010-2018. PLoS One 2021; 16:e0245854. [PMID: 33481904 PMCID: PMC7822332 DOI: 10.1371/journal.pone.0245854] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/10/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To describe drug prescription for gastrointestinal symptoms during pregnancy. METHODS Using the French national health database, we identified pregnancies ending with a birth between April 2010 and December 2018, in France. We studied prescription of antacids, antispasmodics, antinauseants, laxatives and antidiarrheals during pregnancy, between two trimesters before and two trimesters after delivery. We also assessed hospitalization for gastrointestinal symptoms during pregnancy. RESULTS Among 6,365,471 pregnancies, 4,452,779 (74.0%) received at least one gastrointestinal drug during pregnancy; 2,228,275 (37.0%) received an antacid, 3,096,858 (51.5%) an antispasmodic, 1,861,731 (31.0%) an antinauseant, 919,116 (15.3%) a laxative and 617,808 (10.3%) an antidiarrheal. Prescription of proton pump inhibitors doubled from 12.2% in 2010 to 26.0% in 2018, while domperidone use decreased from 18.3% in 2010 to 2.2% in 2018. In addition, prescription of antacids increased from 7.0% during the trimester before pregnancy to 11.8% during the 1st trimester, 17.0% during the 2nd trimester and 23.4% during the 3rd trimester. Antispasmodic use was 10.6% during the trimester before pregnancy, 23.1% during the 1st trimester, 25.2% during the 2nd trimester and 24.0% during the 3rd trimester. Prescription of antinauseant drugs increased from 5.0% during the trimester before pregnancy to 25.7% during the 1st trimester, then decreased to 6.4% during the 2nd trimester and 3.2% during the 3rd trimester. Nausea/vomiting was the most common cause of hospitalization for gastrointestinal symptoms or diseases during pregnancy, although it accounted for only 1.0% of pregnancies. CONCLUSIONS Approximately three-quarters of women use drugs for gastrointestinal symptoms during pregnancy in France. Prescription of gastrointestinal drugs during pregnancy should be the subject of more detailed risk-benefit assessment and recommendations.
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Affiliation(s)
- Antoine Meyer
- GIS-EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, 42 bd de la Libération, Saint Denis, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Université Paris Sud, Le Kremlin Bicêtre, France
| | - Marion Fermaut
- Assistance Publique-Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Jérôme Drouin
- GIS-EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, 42 bd de la Libération, Saint Denis, France
| | - Franck Carbonnel
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Université Paris Sud, Le Kremlin Bicêtre, France
| | - Alain Weill
- GIS-EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, 42 bd de la Libération, Saint Denis, France
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15
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Hjorth S, Wood M, Tauqeer F, Nordeng H. Fertility treatment and oral contraceptive discontinuation for identification of pregnancy planning in routinely collected health data - an application to analgesic and antibiotic utilisation. BMC Pregnancy Childbirth 2020; 20:731. [PMID: 33238915 PMCID: PMC7690077 DOI: 10.1186/s12884-020-03435-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women with unplanned pregnancies use folic acid less frequently, and more often use potentially teratogenic medications in the first trimester. Yet most studies based on routinely collected data lack information on pregnancy planning. Further, only pregnancies proceeding beyond a certain gestational age appear in routinely collected data, creating the possibility for collider-stratification bias. If pregnancy intention could be identified, pregnancies could be ascertained earlier. This study aimed to investigate fertility treatment and discontinuation of oral contraception (OC) as proxies for pregnancy planning by describing variations in patterns of prescription fills for antibiotics and analgesics during the peri-pregnancy period by these proxies of pregnancy intention. METHODS Fertility treatment with clomiphene and discontinuation of OC were identified in the Norwegian Prescription Database (NorPD) and linked with data from the Medical Birth Registry of Norway for the years 2006 to 2017. Filled prescriptions for antibiotics and analgesics from NorPD were displayed for women on fertility treatment, women who discontinued OC before pregnancy, and women who discontinued during pregnancy. RESULTS Of 172,585 included pregnancies, fertility treatment was identified in 19,449, and OC discontinuation before or during pregnancy in 153,136. Women who discontinued OC during pregnancy were less likely to use preconception folic acid (25.4%) than women who discontinued before pregnancy (32.9%), and women on fertility treatment (51.0%). Proportions of first trimester prescription fills were 4.9% (analgesics) and 12.8% (antibiotics) for women who discontinued OC during pregnancy, compared to 4.0 and 11.4% in women who discontinued OC before pregnancy, and 4.7 and 11.0% in women on fertility treatment. CONCLUSIONS There were no substantial differences in patterns of prescription fills for analgesics and antibiotics before or during pregnancy by fertility treatment and OC discontinuation. This suggests that there were few differences in medication use between women with planned and unplanned pregnancies, or that fertility treatment and timing of OC discontinuation from routinely collected health data cannot stand alone in the identification of unplanned pregnancies. A narrower definition of OC discontinuation during pregnancy seemed to be a better proxy, but this should be confirmed in other studies.
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Affiliation(s)
- Sarah Hjorth
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Postboks 1068 Blindern, 0316, Oslo, Norway.
| | - Mollie Wood
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Postboks 1068 Blindern, 0316, Oslo, Norway
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, USA
| | - Fatima Tauqeer
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Postboks 1068 Blindern, 0316, Oslo, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Postboks 1068 Blindern, 0316, Oslo, Norway
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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16
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Ayele Y, Mekuria AN, Tola A, Mishore KM, Geleto FB. Prescription drugs use during pregnancy in Ethiopia: A systematic review and meta-analysis. SAGE Open Med 2020; 8:2050312120935471. [PMID: 32612829 PMCID: PMC7307276 DOI: 10.1177/2050312120935471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/21/2020] [Indexed: 01/13/2023] Open
Abstract
Background The selection of safe drugs for pregnant women in developing countries, such as Ethiopia, where there are limited options of drugs would be challenging. Hence, the aim of this review was to determine the extent of prescribed drugs use and their potential to cause fetal harm among pregnant women in Ethiopia based on the United States Food and Drug Administration risk category. Methods Relevant studies were identified through systematic searches conducted in PubMed, HINARI, Google Scholar and Researchgate. Data on study characteristics and outcomes were extracted using the format developed in Microsoft Excel. The primary measure was pooled prevalence of prescription drugs use during pregnancy. The I2 index was used to assess heterogeneity among studies. The presence of publication bias across studies was evaluated using funnel plot. A random effects model was used to estimate the pooled prevalence. Results A total of nine studies published between 2013 and 2019 were included. The pooled prevalence of prescription drugs during pregnancy, excluding minerals and vitamins, was 45.9 (95%CI: 29.3, 62.5)%. The pooled prevalence of prescription drug use, including minerals and vitamins, was 86.9 (95%CI: 81.2, 92.6)%. The pooled proportion of medications used based on the United States Food and Drug Administration risk category was 56.1 (95%CI: 43.0, 68.4)%, 29.0 (95%CI: 27.9, 30.1)%, 12.1 (95%CI: 7.9, 18.1)%, 4.1 (95%CI: 3.6, 4.6)%, and 2.5 (95%CI: 1.8, 3.6)% for the United States Food and Drug Administration fetal risk category "A," "B," "C," "D," and "X," respectively. Conclusion The use of prescription drugs during pregnancy, excluding supplements, in Ethiopia was high. Drugs with evidence of fetal harm were widely used. Hence, health care providers should select relatively safe drugs. Stakeholders should ensure safe prescribing practice for pregnant women through developing guidelines and updating professionals on the fetal risk status of commonly prescribed drugs.
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Affiliation(s)
- Yohanes Ayele
- Department of Clinical Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abraham Nigussie Mekuria
- Department of Pharmacology, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Assefa Tola
- Department of Epidemiology and Biostatistics, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kirubel Minsamo Mishore
- Department of Clinical Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fisseha Bonja Geleto
- Department of Medical laboratory, College of medicine and health science, Hawassa University, Hawassa, Ethiopia
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17
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Donald S, Sharples K, Barson D, Horsburgh S, Parkin L. Patterns of prescription medicine dispensing before and during pregnancy in New Zealand, 2005-2015. PLoS One 2020; 15:e0234153. [PMID: 32484824 PMCID: PMC7266349 DOI: 10.1371/journal.pone.0234153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/19/2020] [Indexed: 12/21/2022] Open
Abstract
Objective To describe prescription medicine dispensing before and during pregnancy in New Zealand, 2005–2015. Methods Members of the New Zealand Pregnancy Cohort were linked with their dispensing records in a national database of prescription products dispensed from community pharmacies. We identified the proportion of pregnancies during which at least one prescription medicine was dispensed, the number of different medicines used and the most commonly dispensed medicine groups both during pregnancy and in the 270 days before conception. Dispensing during pregnancy was assessed by several maternal characteristics. Results 874,884 pregnancies were included. Over the study timeframe, the proportion of pregnancies exposed to a non-supplement prescription medicine increased from 38.5% to 67.2%. The mean number of different non-supplement medicines dispensed during pregnancy increased from 2.5 to 3.2. Dispensing during pregnancy was weakly associated with body mass index, smoking status and ethnicity. Pregnancy exposure was highest for Antibacterials (26.0%), Analgesics (16.7%) and Antinausea & Vertigo Agents (11.0%). Conclusions From 2005–2015, both the proportion of exposed pregnancies and the number of different medicines dispensed to pregnant women in New Zealand increased.
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Affiliation(s)
- Sarah Donald
- Pharmacoepidemiology Research Network, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- * E-mail:
| | - Katrina Sharples
- Pharmacoepidemiology Research Network, Dunedin, New Zealand
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - David Barson
- Pharmacoepidemiology Research Network, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Pharmacoepidemiology Research Network, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Lianne Parkin
- Pharmacoepidemiology Research Network, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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18
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Raherison C, Hamzaoui A, Nocent-Ejnaini C, Essari LA, Ouksel H, Zysman M, Prudhomme A. [Woman's asthma throughout life: Towards a personalized management?]. Rev Mal Respir 2020; 37:144-160. [PMID: 32057504 DOI: 10.1016/j.rmr.2019.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/18/2019] [Indexed: 11/30/2022]
Abstract
In a woman's life, asthma can affect her in a variety of ways, with the onset of premenstrual asthma currently under-diagnosed. It is estimated that about 20% of women with asthma have premenstrual asthma, which is more common in patients with severe asthma. Women with asthma are at high risk of exacerbations and of severe asthma. Asthma is the most common chronic disease during pregnancy with potential maternal and foetal complications. Asthma medications are safe for the foetus and it is essential to continue pre-existing treatment and adapt it to the progress of asthma during the pregnancy. Sex steroids modulate the structure and function of bronchial and immune cells. Understanding their role in asthma pathogenesis is complicated by the ambivalent effects of bronchodilating and pro-inflammatory oestrogens as well as the diversity of response to their association with progesterone. Menopausal asthma is a clinical entity and is part of one of the phenotypes of severe non-allergic and low steroid-sensitive asthma. Targeted assessment of the domestic and professional environment allows optimization of asthma management.
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Affiliation(s)
- C Raherison
- Service des maladies respiratoires, pôle cardiothoracique, INSERM U1219, université de Bordeaux, CHU Bordeaux, 146, rue Léo-Saignat, 33604 Bordeaux, France.
| | - A Hamzaoui
- Pavillon B, unité de recherche UR12 SP15, hôpital Abderrahmen Mami, faculté de médecine, université de Tunis El Manar, Ariana, Tunisie
| | | | - L-A Essari
- Département de pneumologie, CHRU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - H Ouksel
- Département de pneumologie, CHU d'Angers, Angers, France
| | - M Zysman
- UMR_S955, université Paris-Est Créteil (UPEC), 94000 Créteil, France; Inserm, U955, Team 4, 94000 Créteil, France
| | - A Prudhomme
- Service de pneumologie, CHG Tarbes, Tarbes, France
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19
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Longo C, Forget A, Schnitzer M, Blais L. Timing of Maternal Asthma Diagnosis in Relation to Adverse Perinatal Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1938-1946.e4. [PMID: 32018035 DOI: 10.1016/j.jaip.2020.01.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/07/2020] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND It is unclear if asthma diagnosed during pregnancy puts the fetus at a higher risk of poor perinatal outcomes than pre-existing asthma. OBJECTIVE To assess if the risks of prematurity, major malformations, and small-for-gestational age (SGA) are higher in women with asthma diagnosed during versus pre-pregnancy. METHODS We retrospectively analyzed a cohort of pregnant women aged ≥15 years with and without incident asthma, constructed from health administrative databases. Follow-up began 24 months before pregnancy onset (cohort entry) and ended at delivery. Incident asthma was defined as a first diagnosis among those without asthma in the 8 years before cohort entry. Time was classified into pre-pregnancy and each trimester until delivery. We fit inverse probability weighted Poisson models to estimate marginal relative risks (RRs) for prematurity (delivery <37th week), major malformations, and SGA (birth weight <10th percentile) comparing women with and without asthma, assessing the asthma timing of diagnosis interaction term via a Wald test. RESULTS In a cohort of 122,880 deliveries, the increased risk of prematurity, but not SGA, due to incident asthma was higher in those diagnosed during the second (RR, 1.34; 95% confidence interval [CI], 1.08-1.65; Wald P = .05) and third (RR, 1.93; 95% CI, 1.62-2.29; Wald P < .01) trimesters relative to pre-pregnancy (RR, 1.06; 95% CI, 0.98-1.15). A trend toward an increased risk of major malformations was observed in those diagnosed during the first trimester (RR, 1.18; 95% CI, 0.94-1.49; Wald P = .15) than pre-pregnancy (RR, 0.99; 95% CI, 0.92-1.07). CONCLUSIONS Asthma diagnosed during, versus before, pregnancy was associated with a greater prematurity risk, suggesting an important role of preconception and prenatal screening.
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Affiliation(s)
- Cristina Longo
- Faculty of Pharmacy, University of Montreal, Montréal, QC, Canada.
| | - Amélie Forget
- Faculty of Pharmacy, University of Montreal, Montréal, QC, Canada
| | | | - Lucie Blais
- Faculty of Pharmacy, University of Montreal, Montréal, QC, Canada; Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, QC, Canada; Endowment Pharmaceutical Chair AstraZeneca in Respiratory Health, Montréal, QC, Canada
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Atmadani RN, Nkoka O, Yunita SL, Chen YH. Self-medication and knowledge among pregnant women attending primary healthcare services in Malang, Indonesia: a cross-sectional study. BMC Pregnancy Childbirth 2020; 20:42. [PMID: 31948428 PMCID: PMC6966862 DOI: 10.1186/s12884-020-2736-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 01/10/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Self-medication with over-the-counter (OTC) drugs is an important public health concern, especially in the vulnerable population of pregnant women due to potential risks to both the mother and fetus. Few studies have studied how factors, such as knowledge, affect self-medication. This study investigated self-medication and its associated factors among pregnant women attending healthcare services in Malang, Indonesia. METHODS A cross-sectional study was conducted from July to September 2018 in five healthcare services. A self-administered questionnaire was used and the data were analyzed using multiple regression models. RESULTS Of 333 female participants, 39 (11.7%) used OTC medication. Women with a higher level of knowledge of OTC medication were more likely to self-medicate-adjusted odds ratio (aOR) = 2.15, 95% confidence interval (CI) = 1.03-4.46. Compared with those with less knowledge, pregnant women with more correct knowledge of the possible risk of self-medication were less likely to self-medicate-aOR = 0.29; 95% CI = 0.14-0.60. The effect of a higher level of knowledge of OTC medication was significant among women who had middle school and lower education-aOR = 8.18; 95% CI = 1.70-39.35. The effect of correct knowledge on the possible risks of self-medication was significant only among women with high school and higher education-aOR = 0.17; 95% CI = 0.07-0.42. CONCLUSION Imparting specific knowledge of the potential risks of using non-prescribed medication during pregnancy may help pregnant women navigate and more safely manage their OTC use. We also suggest further collecting data from more healthcare services, such as hospitals, to obtain more findings generalizable to the Indonesian community.
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Affiliation(s)
- Rizka Novia Atmadani
- Pharmacy Department, Faculty of Health Science, University of Muhammadiyah Malang, Kampus II, Malang, Indonesia.,School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Owen Nkoka
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Sendi Lia Yunita
- Pharmacy Department, Faculty of Health Science, University of Muhammadiyah Malang, Kampus II, Malang, Indonesia.,School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
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21
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Zhang J, Ung COL, Guan X, Shi L. Safety of medication use during pregnancy in mainland China: based on a national health insurance database in 2015. BMC Pregnancy Childbirth 2019; 19:459. [PMID: 31795963 PMCID: PMC6892234 DOI: 10.1186/s12884-019-2622-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background Medication safety during pregnancy has drawn global attention, little of which has been reported about the Chinese population. This study aims to describe patterns and risks of medication use among pregnant women in mainland China with reference to the U.S. Food and Drug Administration (FDA) pregnancy risk category. Methods Hospital diagnostic and drug dispensing information of a national representative sample of basic medical insurance (BMI) beneficiaries was obtained from the China Health Insurance Association (CHIRA) database in 2015. Prevalence of use and number of medicines involved in each risk category were calculated. Most commonly used medicines from each risk category were illustrated. Factors associated with the use of category D/X medicines were evaluated through multiple logistic regression. Results Out of 11,373 women who had singleton deliveries in 2015, there were 2896 women with records covering their entire pregnancies, 5377, and 7946 women with records through the 2nd, and the 3rd trimester, respectively. It was found that 11.1% pregnant women used at least one medication and a total of 321 medications had been used during pregnancy. Most pregnant women used medicines which were classified FDA category C (66.2%), followed by category B (57.8%), category A (16.8%), category X (7.5%) and category D (5.0%). The most commonly used medicines from category D and X were anxiolytics and hormonal preparations respectively. Women who were from mid-western area (p = 0.045) or used four or more medications (p < 0.001) were more likely to use category D/X medicines. Conclusions This study revealed that about one in ten pregnant women used at least one medication during pregnancy in China and a significant number of them used FDA Category D or X medicines. The usage patterns identified in the present study indicate that sub-optimal medicine use might exist warranting further evaluation and intervention in future studies. More efforts are needed to uncover the safety concerns about medication use during pregnancy and improve current information system for clinical practice.
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Affiliation(s)
- Jingyuan Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China. .,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA. .,International Research Center for Medicinal Administration, Peking University, Beijing, China.
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China. .,International Research Center for Medicinal Administration, Peking University, Beijing, China.
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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: 9] [Impact Index Per Article: 1.8] [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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Abstract
Information on the safety of medication use during pregnancy and breastfeeding is scarce, yet use of medication among pregnant and breastfeeding women is widespread. The pREGnant, the Dutch Pregnancy Drug Register, was set up to obtain insight into medication use among pregnant and breastfeeding women and potential effects on maternal and fetal/infant health. The systematically documented, good quality data on medication use during pregnancy and lactation in pREGnant will be used in signal detection, epidemiologic studies and counseling of healthcare providers and patients. The register has a prospective cohort design. The population is derived from pregnant women throughout the Netherlands. Data collection started in April 2014 and enrollment of women is continuous and is characterized by a relative high proportion of women born in the Netherlands with a high education compared with the general Dutch pregnant population. Data on current pregnancy, obstetric history, maternal lifestyle, health and medication use, delivery, and infant health are collected through web-based questionnaires completed by the participating women (three times during pregnancy and three times during the infant’s first year of life). If permission is given, the self-reported data can be complemented with information retrieved from Perined, the perinatal registry of the Netherlands, and from obstetric and medical records, and/or pharmacy records. Here, we provide detailed information on the design of the pREGnant, the Dutch Pregnancy Drug Register, as well as descriptive information on characteristics of the participants so far. Currently, steps are being taken to implement the register on a large scale in the Netherlands.
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Choi SK, Kim YH, Kim SM, Wie JH, Lee DG, Kwon JY, Song JH, Lee SJ, Park IY. Opioid analgesics are the leading cause of adverse drug reactions in the obstetric population in South Korea. Medicine (Baltimore) 2019; 98:e15756. [PMID: 31124960 PMCID: PMC6571384 DOI: 10.1097/md.0000000000015756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Medication use during pregnancy is gradually increasing; however, the safety of this practice remains largely unknown.We investigated medications with the most adverse drug reactions (ADRs) among pregnant women and the clinical features of those medications.Reports of ADRs among pregnant women were extracted from the Korea Adverse Events Reporting System (January 2012-December 2015). We analyzed the data of drugs frequently reported to cause ADRs and their clinical features among 3 age groups.A total of 5642 ADRs among 3428 patients were analyzed. The number of ADR reports increased annually. The most common drug categories causing ADRs were analgesics, followed by gynecologic, uterotocolytic, anti-infective, antidiabetic, analgesic, and antihypertensive drugs. Analgesics comprised 6 opioids (morphine, fentanyl, hydromorphone, oxycodone, tramadol, pethidine) and an anti-pyretics (nefopam and ketorolac). As an individual drug, ritodrine (24.4%) was the most frequently reported, followed by morphine, 5-HT3 serotonin antagonist, nefopam, fentanyl, magnesium sulfate, insulin lispro, cefazedone, sodium chloride, hydromorphone, oxycodone, cefotetan, nifedipine, human insulin, tramadol, ketorolac, pethidine, methylergometrine, metoclopramide, and misoprostol (in that order). ADRs most frequently occurred in women aged 25 to 34 years, and the trend of ADR with the 20 most commonly reported medications significantly differed among the age groups (P = .011). In addition, the kind of common causative drugs was different among the age groups.Knowledge of medications and clinical conditions resulting in the highest ADR rates among pregnant women is necessary for medical practitioners to administer proper care.
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Affiliation(s)
- Sae Kyung Choi
- Department of Obstetrics and Gynecology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon
| | - Yeon Hee Kim
- Department of Obstetrics and Gynecology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggido
| | - Su Mi Kim
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon
| | - Jung Ha Wie
- Department of Obstetrics and Gynecology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St, Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Ji Young Kwon
- Department of Obstetrics and Gynecology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Jeong Hwa Song
- Department of Obstetrics and Gynecology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon
| | - Su Jeong Lee
- Department of Obstetrics and Gynecology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggido
| | - In Yang Park
- Department of Obstetrics and Gynecology, Seoul St, Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Desalu OO, Adesina KT, Ojuawo OB, Ogunlaja IP, Alaofin WA, Aladesanmi AO, Opeyemi CM, Oguntoye MS, Salami AK. Prevalence of asthma and respiratory symptoms during pregnancy in the middle belt of Nigeria. J Asthma 2019; 57:703-712. [PMID: 31017029 DOI: 10.1080/02770903.2019.1606236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Information about the burden of asthma during pregnancy in Africa is scarce.Objectives: To determine the prevalence of asthma and respiratory symptoms in pregnancy in Ilorin, Nigeria.Methods: This study uses the European Community Respiratory Health Survey (ECRHS) questionnaire and definitions to screen 870 pregnant women attending three hospitals for asthma.Results: The prevalence of possible asthma (i.e. awakened by shortness of breath, asthma attack(s) in the last 12 months, or currently taking asthma medication) was 2.1% (95% CI: 1.3-3.1%), physician-diagnosed asthma was 1.0% (95% CI: 0.5-1.7%), and current asthma (asthma attack in the last 12 months and currently taking asthma medication) was 0.7% (95% CI: 0.2-1.3%). The prevalence of respiratory symptoms ranged from 0.6% (95% CI: 0.1-1.1%) for wheezing without cold to 12.9% (95% CI: 10.7-15.2%) for nasal allergies. Less than 1% reported an asthma attack and using asthma medication in the last 12 months. None of the pregnant women smoked tobacco during pregnancy. Pregnant women with possible asthma experienced more respiratory symptoms and worsening symptoms than those without asthma (15.8% vs. 3.9%), and the most reported symptom was being awakened by shortness of breath. The majority (55.6%) with physician-diagnosed asthma had suffered an asthma attack in the current pregnancy with a median of two attacks.Conclusion: The prevalence of asthma and respiratory symptoms in pregnancy in this sample was low, but we observed an increase and worsening of respiratory symptoms during pregnancy in those with asthma. Hence, the priority of clinicians should be disease control to prevent feto-maternal morbidity and mortality.
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Affiliation(s)
- Olufemi O Desalu
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Kikelomo T Adesina
- Departments of Obstetrics and Gynaecology, University of Ilorin Teaching Hospital, Ilorin
| | - Olutobi B Ojuawo
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Idowu P Ogunlaja
- Departments of Obstetrics and Gynaecology, Kwara State Specialist Hospital, Ilorin, Nigeria
| | - Wemimo A Alaofin
- Departments of Medicine, Kwara State Specialist Hospital, Ilorin, Nigeria
| | | | | | - Micheal S Oguntoye
- Department of Epidemiology, Kwara State Ministry of Health, Ilorin, Nigeria
| | - Alakija K Salami
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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La banque de données néerlandaise sur les médicaments pendant la grossesse : une bonne idée pour le Canada? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:410-412. [DOI: 10.1016/j.jogc.2019.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Vorstenbosch S, Kant A, Dabekausen Y. The Dutch Pregnancy Drug Register: A Good Idea for Canada? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:407-409. [PMID: 30595513 DOI: 10.1016/j.jogc.2018.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/01/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Saskia Vorstenbosch
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands.
| | - Agnes Kant
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | - Yvonne Dabekausen
- Dutch Society for Obstetrics and Gynaecology (NVOG), Utrecht, The Netherlands
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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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Donald S, Barson D, Horsburgh S, Sharples K, Parkin L. Generation of a pregnancy cohort for medicine utilisation and medicine safety studies in New Zealand. Pharmacoepidemiol Drug Saf 2018; 27:1335-1343. [PMID: 30394649 DOI: 10.1002/pds.4671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/07/2018] [Accepted: 09/07/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this study was to use national health databases to assemble a pregnancy cohort for undertaking medicine utilisation and safety studies in New Zealand. METHOD Pregnancies conceived between January 2005 and March 2015 were identified in the National Maternity Collection, the National Minimum Dataset, the Mortality Collection, and the Laboratory Claims Collection. Pregnancy start and end dates were calculated and used in conjunction with the National Health Index number to merge the records from the four collections to create the New Zealand Pregnancy Cohort. Records of live born and stillborn infants identified in the National Maternity Collection and the Mortality Collection that were linkable with a cohort member formed the baby cohort. RESULTS The cohort consists of 941 468 pregnancies to 491 272 women. One-third of the pregnancies, predominantly early pregnancy losses and terminations, were not found in the National Maternity Collection. Records of 632 090 live born or stillborn infants are linked with 623 099 pregnancies. CONCLUSIONS The New Zealand Pregnancy Cohort is a comprehensive collection of virtually all pregnancies which ended in a live or stillbirth and many, though not all, which ended as early pregnancy losses or terminations in New Zealand over the past decade, and better represents the pregnant population than a cohort generated from the National Maternity Collection alone would do. This cohort will be valuable for investigating patterns of medicine use during pregnancy in New Zealand and developing a fuller understanding of potential impacts of foetal exposure in early pregnancy.
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Affiliation(s)
- Sarah Donald
- Pharmacoepidemiology Research Network, Dunedin, New Zealand.,Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - David Barson
- Pharmacoepidemiology Research Network, Dunedin, New Zealand.,Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Pharmacoepidemiology Research Network, Dunedin, New Zealand.,Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Pharmacoepidemiology Research Network, Dunedin, New Zealand.,Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Lianne Parkin
- Pharmacoepidemiology Research Network, Dunedin, New Zealand.,Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Navaro M, Vezzosi L, Santagati G, Angelillo IF. Knowledge, attitudes, and practice regarding medication use in pregnant women in Southern Italy. PLoS One 2018; 13:e0198618. [PMID: 29920515 PMCID: PMC6007931 DOI: 10.1371/journal.pone.0198618] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 05/22/2018] [Indexed: 12/31/2022] Open
Abstract
The study assessed knowledge, attitudes, and medication use of a random sample of pregnant women attending outpatient Gynecology and Obstetrics clinics at randomly selected public General and Teaching hospitals in Naples, Italy. A total of 503 women participated. Those more likely to know that a pregnant woman with chronic condition must discuss whether or not to take a medication with the physician were Italian, aged 31-40 years, employed, with no history of abortion, having had a medical problem within the previous year, with a better self-perceived health status, who knew how to use medications during pregnancy, and who needed information on medications. The knowledge of the potential risk of using non-prescribed medications during pregnancy was significantly higher in employed women, who received information from physicians, who knew how to use medications during pregnancy, and who knew the possible damages related to medications use. More than half had used at least one medication. Those aged 26-35 years, Italian, non-graduated, in the third trimester, having had a medical problem within the previous year, with a risky pregnancy, and with a knowledge that women with chronic condition must discuss whether or not to take a medication with the physician were more likely to use medication. Less than half had used medication without a physician's advice. Those who were more likely to self-medicate were older, Italian, multiparous, with no history of abortion, who knew that women with chronic condition must discuss whether or not to take a medication with the physician, who did not know the potential risk of using non-prescribed medication during pregnancy, who had used prescribed medication during pregnancy, and who needed information about medications. Educational programs for women about medication use are important to increase their knowledge of the potential risks to the pregnant women and the unborn child in order to reduce self-medication.
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Affiliation(s)
- Monica Navaro
- Department of Experimental Medicine of the University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luigi Vezzosi
- Department of Experimental Medicine of the University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gabriella Santagati
- Department of Experimental Medicine of the University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Italo Francesco Angelillo
- Department of Experimental Medicine of the University of Campania “Luigi Vanvitelli”, Naples, Italy
- * E-mail:
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Ahmed B, Zoega H, Havard A. Renin-angiotensin system blockers in early pregnancy among women with chronic hypertension: getting to the heart of the risk-benefit equation. Int J Epidemiol 2018; 47:683-686. [DOI: 10.1093/ije/dyy066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bilal Ahmed
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Helga Zoega
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Alys Havard
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
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Ibrahim WH, Rasul F, Ahmad M, Bajwa AS, Alamlih LI, El Arabi AM, Dauleh MM, Abubeker IY, Khan MU, Ibrahim TS, Ibrahim AA. Asthma knowledge, care, and outcome during pregnancy: The QAKCOP study. Chron Respir Dis 2018; 16:1479972318767719. [PMID: 29621888 PMCID: PMC6302965 DOI: 10.1177/1479972318767719] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Asthma is the most common chronic medical condition affecting pregnancy.
Optimizing asthma management in pregnancy is paramount for the well-being of
both the mother and the baby. The primary objectives of this study were to
assess patient’s knowledge about asthma, the level of asthma care, and fetal and
maternal outcomes among pregnant asthmatic women in this wealthy country with
tremendous improvement in maternal and fetal health care. The secondary
objective was to identify barriers to asthma control. This was a
cross-sectional, face-to-face, prospective study of 80 pregnant women with
physician-diagnosed asthma. About 56% of patients reported worsening of their
asthma control during pregnancy, of which 52.3% felt this worsening in the third
trimester. About 65% of patients had uncontrolled asthma during their pregnancy,
and inhaler technique was incorrect in 64.4%. Only 38% of patients knew the
difference between controller and reliever asthma medications, 12.7% of patients
had received written asthma action plan, 17% had a spirometry done in the
previous 5 years, and 3.8% had peak expiratory flow meter at home. The main
reasons for uncontrolled asthma were lack of knowledge about right asthma
medications in 30% and fear of side effects of inhaled corticosteroids in 19% of
patients. No financial reason was reported. Significant associations between
total number of pregnancies, poor perception of asthma medications, asthma
exacerbation during delivery and poor asthma control were observed. Preeclampsia
and congenital anomalies occurred at higher rates than previously reported among
general population in this country. The tremendous improvements in maternal
health care and socioeconomic status do not seem to be a barrier to the globally
recognized poor asthma care in pregnancy. Important strategies are much
needed.
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Affiliation(s)
- Wanis H Ibrahim
- 1 Department of Medicine, Hamad General Hospital and Weill-Cornell Medical College, Doha, Qatar
| | - Fatima Rasul
- 2 Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Mushtaq Ahmad
- 2 Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Abeer S Bajwa
- 2 Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Laith I Alamlih
- 2 Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Anam M El Arabi
- 2 Department of Medicine, Hamad General Hospital, Doha, Qatar
| | | | | | - Muhammed U Khan
- 2 Department of Medicine, Hamad General Hospital, Doha, Qatar
| | | | - Azdin A Ibrahim
- 3 Department of Obstetrics and Gynecology, St. Josefs Hospital, Wiesbaden, Germany
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Girit N, Tugrul I, Demirci B, Bozkurt O, Dost T, Birincioglu M, Tanriverdi HA. Drug exposure in early pregnancy might be related to the effects of increased maternal progesterone in implantation period. J Psychosom Obstet Gynaecol 2018. [PMID: 28635531 DOI: 10.1080/0167482x.2017.1289370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AIM This short communication aims to evaluate the relation in between drug exposure time and early pregnancy regarding gestational weeks. METHODS The study covers the referrals made to the Department of Pharmacology for a teratogenic consultation in a 3-year period. From the recordings of pregnant women, the last menstrual period and the starting date of medication were used to determine the time of prescription with regard to gestational weeks. RESULTS In all of the three years, potentially teratogenic medication was prescribed more frequently in the 3rd, 4th and 5th gestational weeks (in between 15-35 days of pregnancy). Approximately 75% of the pregnant women in the study were prescribed with drugs, most frequently with analgesics, antibiotics, gastrointestinal drugs and antidepressants, in these gestational weeks. CONCLUSIONS The timing of prescriptions in early pregnancy frequently coincides with the increased levels of maternal progesterone in implantation period. Progesterone may lead to negative mood symptoms of an increased pain perception, anxiety, irritability and aggression in some of the pregnant women and therefore causes an increased stress condition which in turn may result in pain, infection and inflammation in the individual. Taking the frequently used medications into consideration, the reason for prescriptions in this period might be related to the symptoms originating from the effects of progesterone. Future studies are needed to better demonstrate this association of drug exposure and effects of maternal progesterone in early pregnancy.
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Affiliation(s)
- Necip Girit
- a Department of Medical Pharmacology, Faculty of Medicine , Adnan Menderes University , Aydın , Turkey
| | - Ibrahim Tugrul
- a Department of Medical Pharmacology, Faculty of Medicine , Adnan Menderes University , Aydın , Turkey
| | - Buket Demirci
- a Department of Medical Pharmacology, Faculty of Medicine , Adnan Menderes University , Aydın , Turkey
| | - Ozlem Bozkurt
- b Department of Biophysics, Faculty of Medicine , Adnan Menderes University , Aydın , Turkey
| | - Turhan Dost
- a Department of Medical Pharmacology, Faculty of Medicine , Adnan Menderes University , Aydın , Turkey
| | - Mustafa Birincioglu
- a Department of Medical Pharmacology, Faculty of Medicine , Adnan Menderes University , Aydın , Turkey
| | - H Alper Tanriverdi
- c Department of Obstetrics and Gynecolgy, Perinataology Unit, Faculty of Medicine , Adnan Menderes University , Aydın , Turkey
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Maternal depressive symptoms, maternal asthma, and asthma in school-aged children. Ann Allergy Asthma Immunol 2017; 118:55-60.e1. [PMID: 28007088 DOI: 10.1016/j.anai.2016.10.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about the joint effects of maternal asthma and maternal depression on childhood asthma. OBJECTIVE To examine whether maternal depression and maternal asthma lead to greater risk of childhood asthma than maternal asthma alone. METHODS Cross-sectional studies of children (6-14 years old) in San Juan, Puerto Rico (n = 655) and Sweden (n = 6,887) were conducted. In Puerto Rico, maternal depressive symptoms were defined using the Center for Epidemiologic Studies Depression Scale (CES-D) questionnaire. In Sweden, maternal physician-diagnosed depression was derived from national registries, and maternal depressive symptoms were defined using an abbreviated CES-D questionnaire. Childhood asthma was defined as physician-diagnosed asthma plus current wheeze (in Puerto Rico) or plus medication use (in Sweden). Logistic regression was used for multivariable analysis. RESULTS Compared with Puerto Rican children whose mothers had neither asthma nor depressive symptoms, those whose mothers had asthma but no depressive symptoms had 3.2 times increased odds of asthma (95% confidence interval [CI] = 2.1-4.8) and those whose mothers had asthma and depressive symptoms had 6.5 times increased odds of asthma (95% CI = 3.3-13.0). Similar results were obtained for maternal depression and maternal asthma in the Swedish cohort (odds ratio for maternal asthma without maternal depression = 2.8, 95% CI = 2.1-3.7; odds ratio for maternal asthma and maternal depression = 4.0, 95% CI = 1.7-9.6). Although the estimated effect of maternal asthma on childhood asthma was increased when maternal depressive symptoms (Puerto Rico) or maternal depression (Sweden) was present, there were no statistically significant additive interactions. CONCLUSION Maternal depression can further increase the risk of asthma in children whose mothers have a history of asthma.
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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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Molla F, Assen A, Abrha S, Masresha B, Gashaw A, Wondimu A, Belete Y, Melkam W. Prescription drug use during pregnancy in Southern Tigray region, North Ethiopia. BMC Pregnancy Childbirth 2017; 17:170. [PMID: 28583106 PMCID: PMC5460343 DOI: 10.1186/s12884-017-1359-8] [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: 09/26/2016] [Accepted: 05/26/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Judicious utilization of drugs rescues the fetus from the harmful effects while treating the health problems of the pregnant women. This study aimed at evaluating drug utilization pattern and its associated factors among pregnant women in Southern Tigray, Ethiopia. METHOD Institution based cross-sectional study was conducted among 647 pregnant women who had been attending obstetrics-gynecology and antenatal care units in different health facilities of Southern Tigray region. The study participants were selected using multistage sampling technique. Data collection was done using pre-tested semi-structured questionnaires and by reviewing antenatal follow-up cards. Descriptive and inferential statistics were analyzed, to assess drug utilization pattern and its associated factors among pregnant women, using SPSS version 20 software. RESULTS Of 647 pregnant women, 87.5% were prescribed with at least one medication. As per the United States Food and Drug Administration (US-FDA) risk classification system, 87.7, 7.9, 3.9, and 0.5% of the prescribed drug were from category A, B, C and D, respectively. Prescription drug use was more likely among gynecology ward visitors [AOR = 8.97, 95% Cl (2.69-29.88)] and among those who visited health facilities for the first time during their first [AOR =2.65, 95% Cl (1.44-4.84)] and second [AOR = 2.50, 95% Cl (1.36-4.61)] trimesters. CONCLUSION Majority of the study population used safe and appropriate medications according to US-FDA risk classification system, with the exception of low proportion (0.5%) of medication with potential risk for the fetus. The average number of drug prescribed per pregnant women was in the recommended range of WHO drug use indicators guideline.
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Affiliation(s)
- Fantahun Molla
- Pharmaceutics Department, School of Pharmacy, College of Health Sciences, Mekelle University, Mek'ele, Ethiopia
| | - Admassu Assen
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Solomon Abrha
- Pharmaceutics Department, School of Pharmacy, College of Health Sciences, Mekelle University, Mek'ele, Ethiopia
| | - Birhanetensay Masresha
- Pharmacology and Toxicology Department, School of Pharmacy, College of Health Sciences, Mekelle University, Mek'ele, Ethiopia
| | - Arega Gashaw
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mek'ele, Ethiopia
| | - Abrham Wondimu
- Pharmaceutics Department, School of Pharmacy, College of Health Sciences, Mekelle University, Mek'ele, Ethiopia
| | - Yared Belete
- Social Pharmacy and Pharmacoepidemiology Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mek'ele, Ethiopia
| | - Wondim Melkam
- Pharmacology Department, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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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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Johnson KA, Sjaarda LA, Mumford SL, Garbose RA, Schliep KC, Mattison D, Perkins NJ, Wactawski-Wende J, Schisterman EF. Patterns and prevalence of medication use across the menstrual cycle among healthy, reproductive aged women. Pharmacoepidemiol Drug Saf 2016; 25:618-27. [PMID: 26954695 PMCID: PMC4933290 DOI: 10.1002/pds.3993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 01/22/2016] [Accepted: 02/08/2016] [Indexed: 11/06/2022]
Abstract
PURPOSE The purpose of this study is to characterize the patterns of medication intake in healthy, reproductive-age women not using hormonal contraception. METHODS Two hundered fifty-nine healthy, premenopausal women (18-44 years of age) enrolled in the BioCycle Study (2005-2007) were followed over two menstrual cycles. Women were excluded if they were currently using oral contraceptives or other chronic medications. Over-the-counter and prescription medication use among participants was evaluated daily throughout the study via a diary assessing type of medication, dosage, units, and frequency. Medications were categorized as allergy, antibiotics, central nervous system (CNS), cold and cough, gastrointestinal, musculoskeletal, and pain medication based on primary active ingredient. Medication use within each category was assessed across standardized 28-day cycles to evaluate differences in use across cycle phases (i.e., early, middle, and late). RESULTS Medication use was reported by 73% of participants. The most and least frequently used medications, respectively, were pain (69%) and musculoskeletal medications (1%). Pain, CNS, and antibiotic medication use varied significantly across the cycle, with pain and CNS medication more frequently reported during menses and antibiotics more frequently during the luteal phase. Allergy, cold and cough, gastrointestinal, and musculoskeletal medication use did not vary across the cycle. CONCLUSIONS Patterns of medication use among reproductive age women vary across the menstrual cycle for certain types of medications, particularly in pain (e.g., Ibuprofen), antibiotics (e,g, Amoxicillin), and CNS (e.g., Adderall) medications. Future studies involving use of these types of medication in premenopausal women may need to consider the relationship of their use to the menstrual cycle. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Kristen A Johnson
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Lindsey A Sjaarda
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Sunni L Mumford
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca A Garbose
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Karen C Schliep
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Donald Mattison
- Risk Sciences International and McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON, Canada
| | - Neil J Perkins
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Enrique F Schisterman
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Abstract
Asthma is a common comorbidity during pregnancy and its prevalence is increasing in the community. Exacerbations are a major clinical problem during pregnancy with up to 45% of women needing to seek medical help, resulting in poor outcomes for mothers and their babies, including low birth weight and preterm delivery. The goals of effective asthma management in pregnancy are to maintain the best possible asthma control and prevent exacerbations. This is achieved by aiming to prevent day- and night-time symptoms, and maintain lung function and normal activity. In addition, maintaining fetal oxygenation is an important consideration in pregnancy. Guidelines recommend providing asthma advice and review prior to conception, and managing asthma actively during pregnancy, with regular 4-weekly review, provision of a written action plan, use of preventer medications as indicated for other adults with asthma, and management of comorbid conditions such as rhinitis. Improvements have been made in recent years in emergency department management of asthma in pregnancy, and multidisciplinary approaches are being proposed to optimise both asthma outcomes and perinatal outcomes. One strategy that has demonstrated success in reducing exacerbations in pregnancy is treatment adjustment using a marker of eosinophilic lung inflammation, the exhaled nitric oxide fraction (F eNO). The use of an algorithm that adjusted inhaled corticosteroids (ICS) according to F eNO and added long-acting β-agonists when symptoms remained uncontrolled resulted in fewer exacerbations, more women on ICS but at lower mean doses, and improved infant respiratory health at 12 months of age. Further evidence is needed to determine whether this strategy can also improve perinatal outcomes and be successfully translated into clinical practice. KEY POINTS Asthma is the most common chronic disease to affect pregnant women.Exacerbations occur in up to 45% of pregnant women with asthma.Asthma should be managed during pregnancy as for other adults.Treatment adjustment using a marker of airway inflammation reduces the exacerbation rate in pregnancy. EDUCATIONAL AIMS To identify the goals of and steps associated with effective asthma management in pregnancy.To understand the maternal and perinatal risks associated with asthma during pregnancy.To describe a management strategy that has been shown to reduce exacerbations in pregnant women with asthma.
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Affiliation(s)
- Vanessa E. Murphy
- Centre for Asthma and Respiratory Disease, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
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Charlton RA, Snowball JM, Nightingale AL, Davis KJ. Safety of Fluticasone Propionate Prescribed for Asthma During Pregnancy: A UK Population-Based Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:772-9.e3. [PMID: 26116951 DOI: 10.1016/j.jaip.2015.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 05/06/2015] [Accepted: 05/12/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Asthma is commonly treated during pregnancy, yet data on the safety of asthma medicines used during pregnancy are sparse. OBJECTIVE The objective of this study was to evaluate the safety of the inhaled corticosteroid (ICS) fluticasone propionate (FP), alone and in fixed-dose combination with salmeterol (FSC) in terms of the risk of all major congenital malformations (MCMs), compared with all other non-FP ICS. METHODS Women with asthma who had a pregnancy between January 1, 2000, and December 31, 2010, were identified in the United Kingdom's Clinical Practice Research Datalink. Exposure to asthma medicines during the first trimester of pregnancy was based on issued prescriptions. The mothers' and infants' medical records were linked where possible, and pregnancy outcomes with an MCM diagnosed by age 1 year were identified based on medical codes in the mother's and infant's medical records, including those MCMs prenatally diagnosed that ended in an induced pregnancy termination. The absolute and relative risks of an MCM after different ICS exposures, stratified by the asthma treatment intensity level, were calculated. RESULTS A total of 14,654 mother-infant pairs were identified, of which 6,174 received an ICS prescription during the first trimester, in addition to 13 first trimester ICS exposed pregnancies that ended in an induced termination after a prenatal MCM diagnosis. In total, 5,362 pregnancies were eligible for the primary analysis at age 1 year. The absolute risk of an MCM after any first trimester FP exposure was 2.4% (CI95 0.8-4.1) and 2.7% (CI95 1.8-3.6) for the "moderate" and "considerable/severe" asthma treatment intensity levels, respectively. The adjusted odds ratios when compared with non-FP ICS were 1.1 (CI95 0.5-2.3) and 1.2 (CI95 0.7-2.0) for the "moderate" and "considerable/severe" intensity levels; risks for any FP and for FSC did not differ substantially. CONCLUSION No increase in the overall risk of MCMs was identified after first trimester FP exposure compared with non-FP ICS.
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Affiliation(s)
- Rachel A Charlton
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, United Kingdom.
| | - Julia M Snowball
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, United Kingdom
| | - Alison L Nightingale
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, United Kingdom
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Ersbøll AS, Hedegaard M, Damm P, Johansen M, Tabor A, Hegaard HK. Changes in the pattern of paracetamol use in the periconception period in a Danish cohort. Acta Obstet Gynecol Scand 2015; 94:898-903. [PMID: 25939806 DOI: 10.1111/aogs.12667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 04/28/2015] [Indexed: 11/29/2022]
Abstract
Paracetamol is the most commonly used over-the-counter drug in pregnancy. It is generally considered to be safe, but prolonged antenatal exposure has been associated with offspring short- and long-term morbidity. Our aim was to describe the pattern of paracetamol use with a focus on frequent ingestion (more than once a week), 3 months before and in early pregnancy. In this cohort, 8650 pregnant women responded to a web-based clinical questionnaire that included questions about drug use. Paracetamol was the most used drug before and in early pregnancy (35.2% and 6.5% of respondents, respectively). The proportion of frequent users decreased from 3.9% before to 0.9% in early pregnancy. Frequent paracetamol use was associated with smoking, co-morbidities, body mass index ≥ 25 kg/m(2), unplanned pregnancy, no education and inability to understand Danish. A significant decrease in the proportion of women with any paracetamol use in early pregnancy was noted after access to large packs was restricted by legislation.
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Affiliation(s)
- Anne S Ersbøll
- Research Unit, Women's and Children's Health, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette Hedegaard
- Research Unit, Women's and Children's Health, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Damm
- Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Johansen
- Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Ann Tabor
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Fetal Medicine and Ultrasound, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Hanne K Hegaard
- Research Unit, Women's and Children's Health, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Child, Family, and Reproductive Health, Departments of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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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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Zomerdijk IM, Ruiter R, Houweling LMA, Herings RMC, Straus SMJM, Stricker BH. Dispensing of potentially teratogenic drugs before conception and during pregnancy: a population-based study. BJOG 2014; 122:1119-29. [DOI: 10.1111/1471-0528.13128] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2014] [Indexed: 12/16/2022]
Affiliation(s)
- IM Zomerdijk
- Department of Medical Informatics; Erasmus Medical Centre; Rotterdam the Netherlands
- Department of Epidemiology; Erasmus Medical Centre; Rotterdam the Netherlands
- Dutch Medicines Evaluation Board; Utrecht the Netherlands
| | - R Ruiter
- Department of Epidemiology; Erasmus Medical Centre; Rotterdam the Netherlands
| | - LMA Houweling
- PHARMO Institute for Drug Outcomes Research; Utrecht the Netherlands
| | - RMC Herings
- PHARMO Institute for Drug Outcomes Research; Utrecht the Netherlands
| | - SMJM Straus
- Department of Medical Informatics; Erasmus Medical Centre; Rotterdam the Netherlands
| | - BH Stricker
- Department of Epidemiology; Erasmus Medical Centre; Rotterdam the Netherlands
- Drug Safety Unit; Inspectorate of Health Care; The Hague the Netherlands
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Panchaud A, Weisskopf E, Winterfeld U, Baud D, Guidi M, Eap CB, Csajka C, Widmer N. Médicaments et grossesse : modifications pharmacocinétiques et place du suivi thérapeutique pharmacologique. Therapie 2014; 69:223-34. [DOI: 10.2515/therapie/2014026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/03/2014] [Indexed: 11/20/2022]
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Charlton R, Snowball J, Sammon C, de Vries C. The Clinical Practice Research Datalink for drug safety in pregnancy research: an overview. Therapie 2014; 69:83-9. [PMID: 24698192 DOI: 10.2515/therapie/2014007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 11/18/2013] [Indexed: 11/20/2022]
Abstract
Medicine use during pregnancy is common; however the safety of medicine use during pregnancy is largely unknown when a medicine comes to market. Electronic healthcare databases, including the Clinical Practice Research Datalink (CPRD), are increasingly being used for post-marketing surveillance in this field. The CPRD contains anonymised, longitudinal medical records routinely collected in primary care. Using CPRD data it is possible to identify medical records indicative of pregnancy, including pregnancy losses. Data on prescriptions issued can be used to determine maternal exposure and for about 80% of pregnancies it is possible to link the mother's medical record to the medical record of the child. Data in the medical records of the mother and child can then be used to identify adverse pregnancy outcomes, including congenital malformations. This paper describes some of the complexities involved in using CPRD data for pregnancy related research and discusses some of its strengths and limitations.
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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: 272] [Impact Index Per Article: 27.2] [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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Hansen C, Joski P, Freiman H, Andrade S, Toh S, Dublin S, Cheetham C, Cooper W, Pawloski P, Li DK, Beaton S, Kaplan S, Scott P, Hammad T, Davis R. Medication exposure in pregnancy risk evaluation program: the prevalence of asthma medication use during pregnancy. Matern Child Health J 2013; 17:1611-21. [PMID: 23108737 PMCID: PMC3797257 DOI: 10.1007/s10995-012-1173-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Asthma is one of the most common chronic diseases in women of reproductive age, occurring in up to 8 % of pregnancies. The objective of this study is to assess the prevalence of asthma medication use during pregnancy in a large diverse cohort. We identified women aged 15-45 years who delivered a live born infant between 2001 and 2007 across 11 U.S. health plans within the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). Using health plans' administrative and claims data, and birth certificate data, we identified deliveries for which women filled asthma medications from 90 days before pregnancy through delivery. Prevalence (%) was calculated for asthma diagnosis and medication dispensing. There were 586,276 infants from 575,632 eligible deliveries in the MEPREP cohort. Asthma prevalence among mothers was 6.7 %, increasing from 5.5 % in 2001 to 7.8 % in 2007. A total of 9.7 % (n = 55,914) of women were dispensed asthma medications during pregnancy. The overall prevalence of maintenance-only medication, rescue-only medication, and combined maintenance and rescue medication was 0.6, 6.7, and 2.4 % respectively. The prevalence of maintenance-only use doubled during the study period from 0.4 to 0.8 %, while rescue-only use decreased from 7.4 to 5.8 %. In this large population-based pregnancy cohort, the prevalence of asthma diagnoses increased over time. The dispensing of maintenance-only medication increased over time, while rescue-only medication dispensing decreased over time.
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Affiliation(s)
- Craig Hansen
- Center for Health Research Southeast, Kaiser Permanente Georgia, Atlanta, GA, USA,
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van Gelder MMHJ, Bos JHJ, Roeleveld N, de Jong-van den Berg LTW. Drugs associated with teratogenic mechanisms. Part I: dispensing rates among pregnant women in the Netherlands, 1998-2009. Hum Reprod 2013; 29:161-7. [PMID: 24105826 DOI: 10.1093/humrep/det369] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What are the dispensing rates of drugs suspected to be associated with teratogenic mechanisms among pregnant Dutch women? SUMMARY ANSWER In a substantial proportion of pregnancies in our study population at least one drug associated with a teratogenic mechanism was dispensed in the first trimester of pregnancy. WHAT IS KNOWN ALREADY The main teratogenic mechanisms of medical drugs that may affect fetal development in the first trimester of pregnancy have been described previously. However, information on the dispensing rate of such drugs among women at all stages of pregnancy is lacking. STUDY DESIGN, SIZE, DURATION To determine how often medications suspected to be associated with a teratogenic mechanism are used by pregnant women, we studied 32 016 pregnancies included in the IADB.nl database between 1998 and 2009. PARTICIPANTS/MATERIALS, SETTING, METHODS We estimated dispensing rates of medical drugs suspected to be associated with teratogenic mechanisms in our study population. The IADB.nl database includes all pharmacy dispensings for an estimated population of 220 000 in 1994-1998 and c.500 000 since 1999. In addition, trends in first trimester dispensing rates over time and patterns of receiving multiple drugs associated with teratogenic mechanisms were evaluated. In addition, we determined the number of pregnancies in which multiple prescription drugs from one or more teratogenic categories were dispensed in the first trimester, and we evaluated the numbers of different medications dispensed that could be grouped within a specific teratogenic mechanism. MAIN RESULTS AND THE ROLE OF CHANCE In 175 per 1000 pregnancies [95% confidence interval (CI), 171-179] at least one drug associated with a teratogenic mechanism was dispensed in the first trimester. The total dispensing rate was 236 per 1000 pregnancies (95% CI 232-241) in the 3 months before pregnancy and an increasing trend was seen in the second [214 per 1000 (95% CI 209-218)] and third [327 per 1000 (95% CI 322-332)] trimesters. The first trimester dispensing rates increased between 1998 and 2009 for selective serotonin-reuptake inhibitors (P < 0.001) and serotonin receptor agonists/antagonists (P < 0.001). In 71.8% of pregnancies in which drugs associated with teratogenic mechanisms were dispensed in the first trimester, women received drugs related to only one mechanism. Of the pregnancies in which drugs from multiple teratogenic categories were dispensed in the first trimester, 1148 (72.6%) women received drugs from 2 categories, 317 (20.0%) from three categories, 88 (5.6%) from 4 categories, 28 (1.8%) from 5 categories and 1 from 6 categories. Several women received multiple prescription medications grouped within a single teratogenic mechanism in the first trimester, ranging between 13.3% for cyclo-oxygenase inhibitors and 41.8% for serotonin receptor agonists/antagonists. LIMITATIONS, REASONS FOR CAUTION We used a dispensing database, therefore actual use of the medication prescribed is unknown and non-compliance could have led to overestimation of exposure prevalences. WIDER IMPLICATIONS OF THE FINDINGS Owing to the uncertainties concerning the safety of medication use during pregnancy, the results of this study stress the need for cautious prescription of medication associated with teratogenic mechanisms to women of reproductive age. This is further supported by our finding that women received multiple prescription medications grouped within a single teratogenic mechanism in the first trimester, which would theoretically increase strongly the risk of birth defects. STUDY FUNDING/COMPETING INTEREST(S) Marleen van Gelder was supported by the Netherlands Organisation for Scientific Research/NWO (grant no. 021.001.008). No competing interests are declared. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Marleen M H J van Gelder
- Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen 6500 HB, The Netherlands
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