Prescriptions et délivrances d’anti-inflammatoires non stéroïdiens après le 6e mois de grossesse : impact d’une lettre d’information envoyée par les autorités de santé

[Tooth and pregnancy, a public health issue]

Pregnancy is a particularly risky moment for periodontal and oral healthcare. The main diseases encountered are the development or worsening of carious lesions and gestational periodontal diseases such as gingivitis, epulis or gestational periodontitis. There is a lack of knowledge from health professionals and their patients, firstly on the link between poor oral hygiene and the impact on pregnancy, and secondly on the feasibility of oral care during pregnancy. There is a link between periodontal diseases and the increase of premature delivery risk, child with low birth weight and pre-eclampsia. Periodontal care during pregnancy would lower this risk. However, no link has been highlighted to date between oral care provided during pregnancy and the reduction of premature delivery or even of pre-eclampsia. Loco-regional anaesthesia and taking x-ray images-even dental panoramic radiography-are not contraindicated for pregnant women. All periodontal and oral care can be performed during pregnancy, at all gestational ages.

Relevance of a "Dear Doctor letter" to alert healthcare providers to new recommendations for vitamin D administration

PURPOSE

After reports of malaise in infants immediately after the oral administration of two brands of vitamin D solutions, a "Dear Doctor letter" (DDL) containing recommendations for the administration of vitamin D was sent to all French paediatricians and pharmacies and a large number of French general practitioners (GPs) with a predominantly paediatric practice. The DDL and a press release were published on the French Medicines Agency website and distributed via a mailing list. The objective of this study was to assess the effectiveness of such a DDL and to collect the opinions of healthcare professionals on the best way to provide them with information.

METHODS

A questionnaire was sent to a national random sample of 145 paediatricians, 680 GPs and 230 pharmacists.

RESULTS

Only 49% of responding paediatricians, 48% of GPs and 67% of pharmacists were aware of the warning. Among the participating healthcare professionals aware of the warning and who prescribed/dispensed these vitamins, 50% of paediatricians and 68% of GPs stated that they had changed their prescribing behaviour, and 68% of pharmacists stated that they had modified their advice when dispensing. According to the responding healthcare professionals, postal letters remained the best way to issue safety warnings. Some of the respondents suggested that the DDL be more distinctive in terms of being a DDL and that the information be more widely disseminated to other stakeholders involved in the healthcare system.

CONCLUSIONS

This survey of a national random sample of healthcare professionals revealed that many of the respondents paid little attention to the DDL and were therefore unlikely to change their practices. A potential supplementary method for disseminating recommendations for medicine administration could be to apply stickers on medicine boxes, as this approach has the additional advantage of directly informing the concerned population, i.e. the parents.

Pharmacoepidemiological research using French reimbursement databases: yes we can!

PURPOSE

To describe the reimbursement databases available in France for pharmacoepidemiological research and their use.

METHODS

France has a publicly funded health system that systematically covers the population. Within this system, three main insurance schemes provide health services to citizens in France and each have their own reimbursement database. Together these three databases cover almost 97% of the French population (respectively for 54.5, 3.6, and 3.3 million individuals, and a total of 61.4 million individuals). Data in these concern patients, prescribers, all the medical acts reimbursed, prescription and undertaking of laboratory tests (but without results), private hospital data, partial public hospital data and vital status. Their use is regulated but access is free and the data are anonymous. PubMed and Scopus were searched for relevant studies published from January 1988 to June 2009.

RESULTS

110 published studies were included. The topics and the study characteristics were extremely wide-ranging. The studies assessed patterns of drug use, have tested interventions, supported or improved prescribing practices, tested compliance with the French governmental Health guidelines, assessed physicians' prescribing practices and performed economic and cost-effectiveness assessments. The number of articles published increased greatly between 2002 and 2003.

CONCLUSIONS

The French reimbursement databases were greatly used over the last 20 years. They can provide data on exposure to drugs and can be used to study patterns of drug utilization although their limitations must be considered.

What do pregnant women know about non-steroidal anti-inflammatory drugs?

OBJECTIVE

Non-steroidal anti-inflammatory drug (NSAID) use on late pregnancy can be associated with severe adverse neonatal outcomes. Some NSAIDs, available over the counter, can be purchased easily by pregnant women. The present study evaluates pregnant womens' knowledge about NSAID use in pregnancy.

STUDY DESIGN

The survey includes 250 pregnant women in South-west France. Women have been interviewed about their knowledge on analgesic and NSAID use in pregnancy.

RESULTS

A total of 2% pregnant women use aspirin or ibuprofen as self-medication. More than 10% of the women think that it is safe to take NSAIDs on late pregnancy. A majority of them thought that aspirin and ibuprofen are not NSAIDs.

CONCLUSION

NSAID risks in pregnancy are insufficiently known. Adequate information must be provided not only to medical practitioners and pharmacists but also to pregnant women especially for drugs which are available over the counter.

[Over the counter medication in pregnant women]

A prospective survey is conducted in a population of pregnant women in order to evaluate the prevalence of pregnant women using over the counter medication, to define their profile and to evaluate the information received about prenatal drug exposure and teratogen risk. During the study period, 223 women were interviewed, 23.3% of them use over the counter medication. In most cases, the drugs are "comfort drug". One woman, only, had taken anti-inflammatory during the first trimester. Only 51% had received information on drug and teratogen risk. Self medication is not frequently used by the pregnant women. The information provided by health professionals, about the risk and OTC medications during pregnancy, is insufficient.