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Louchet M, Collier M, Beeker N, Mandelbrot L, Sibiude J, Chouchana L, Treluyer JM. Trends in harmful drug exposure during pregnancy in France between 2013 and 2019: A nationwide cohort study. PLoS One 2024; 19:e0295897. [PMID: 38198446 PMCID: PMC10781191 DOI: 10.1371/journal.pone.0295897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE Describe the trends of exposure to harmful drugs during pregnancy over recent years in France. DESIGN Nationwide cohort study. SETTING The French National administrative health Data System (SNDS). POPULATION Pregnancies starting between 2013 and 2019 and outcomes corresponding to live births, medical terminations of pregnancy, and stillbirths. METHODS Each pregnancy was divided into a preconceptional period of 90 days before conception and three trimesters from conception to birth. Harmful drugs were defined according to their risks to the fetus: teratogenicity or fetotoxicity. Exposure was defined using the critical period during pregnancy for each type of harmful drug: preconceptional period or first trimester for teratogenic drugs and second or third trimesters for fetotoxic drugs. MAIN OUTCOME MEASURES Prevalence of pregnancies exposed to at least one harmful drug. RESULTS Among 5,253,284 pregnancies, 204,402 (389 per 10,000) pregnancies were exposed to at least one harmful drug during the critical periods: 48,326 (92 per 10,000) pregnancies were exposed to teratogenic drugs during the preconceptional period or the first trimester, and 155,514 (299 per 10,000) pregnancies were exposed to fetotoxic drugs during the second or third trimesters. Teratogenic drugs were mainly retinoids for topical use (44 per 10,000 pregnancies), antiepileptics (13 per 10,000 pregnancies) and statins (13 per 10,000 pregnancies). Fetotoxic drugs were mainly non-steroidal anti-inflammatory drugs (NSAIDs), for systemic (128 per 10,000 pregnancies) and topical use (122 per 10,000 pregnancies). Exposure to teratogenic drugs decreased from the preconceptional period to the first trimester. Exposure to fetotoxic drugs decreased from the second to the third trimester. Between 2013 and 2019, we found a decrease in harmful drug exposure overall, mainly for topical and systemic NSAIDs and for topical retinoids. CONCLUSIONS In this nationwide study, about one in 25 pregnancies was exposed to at least one harmful drug, mainly NSAIDs and topical retinoids. Although the prevalence of harmful drug exposure decreased over the study period, NSAID exposure in the second and third trimester remains of concern.
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Affiliation(s)
- Margaux Louchet
- UPR7323 “Pharmacology and Drug Evaluatioán in Children and Pregnant Women”, Université Paris Cité, Paris, Île-de-France, France
- Fédération Hospitalo-Universitaire PREMA, Université Paris Cité, Paris, Île-de-France, France
| | - Mathis Collier
- UPR7323 “Pharmacology and Drug Evaluatioán in Children and Pregnant Women”, Université Paris Cité, Paris, Île-de-France, France
- Clinical Research Unit, Université de Paris CIC P1419, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Nathanaël Beeker
- UPR7323 “Pharmacology and Drug Evaluatioán in Children and Pregnant Women”, Université Paris Cité, Paris, Île-de-France, France
- Clinical Research Unit, Université de Paris CIC P1419, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
- INSERM Infection, Antimicrobials, Modelling, Evolution U1137, Université Paris Cité, Paris, Île-de-France, France
| | - Jeanne Sibiude
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
- INSERM Infection, Antimicrobials, Modelling, Evolution U1137, Université Paris Cité, Paris, Île-de-France, France
| | - Laurent Chouchana
- UPR7323 “Pharmacology and Drug Evaluatioán in Children and Pregnant Women”, Université Paris Cité, Paris, Île-de-France, France
- Department of Perinatal Pediatric and Adult Pharmacology, Regional Pharmacovigilance Center, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Jean Marc Treluyer
- UPR7323 “Pharmacology and Drug Evaluatioán in Children and Pregnant Women”, Université Paris Cité, Paris, Île-de-France, France
- Clinical Research Unit, Université de Paris CIC P1419, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
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Christensen JJ, Bogsrud MP, Holven KB, Retterstøl K, Veierød MB, Nordeng H. Use of statins and other lipid-modifying agents across pregnancy: A nationwide drug utilization study in Norway in 2005-2018. Atherosclerosis 2023; 368:25-34. [PMID: 36522216 DOI: 10.1016/j.atherosclerosis.2022.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Statins are becoming more widely used among women of reproductive age; however, nationwide data on statin use across pregnancy is scarce. We therefore aimed to describe the drug utilization patterns for statins and other lipid-modifying agents (LMAs) before, during, and after pregnancy, for all pregnancies in Norway from 2005 to 2018. METHODS We linked individual-level data from four nationwide electronic health care registries in Norway and characterized the prescription fills of statins and other LMAs across pregnancy. We also examined trends in pregnancy-related LMA use, and characterized women using statins and other LMAs on parameters of health status and co-morbidity. RESULTS In total, 822,071 pregnancies for 503,723 women were included. The number of statin prescription fills decreased rapidly during the first trimester and returned to pre-pregnancy levels about one year postpartum. Pregnancy-related statin use increased from 2005 (approx. 0.11% of all pregnancies) to 2018 (approx. 0.29% of all pregnancies); however, in total, few statin prescriptions were filled within any trimester of pregnancy (n = 331, 0.04% of all pregnancies). Statin use was more common in women with higher age, higher weight, smoking, and comorbidities such as hypertension and diabetes mellitus; also, statin users often had co-medication pertinent to these conditions. CONCLUSIONS Although statins and other LMAs were increasingly being used around the time of pregnancy among women in Norway, drug use was mostly discontinued during the first trimester. Our results suggest that pregnancy-related statin use should be monitored, and that drug safety analyses for maternal and offspring health outcomes are needed.
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Affiliation(s)
| | - Martin P Bogsrud
- Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Oslo, Norway
| | - Kjetil Retterstøl
- Department of Nutrition, University of Oslo, Oslo, Norway; The Lipid Clinic, Oslo University Hospital, Oslo, Norway
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group and PharmaTox Strategic Research Initiative, University of Oslo, Oslo, Norway; Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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Toxicity of Glycyl-l-Prolyl-l-Glutamate Pseudotripeptides: Cytotoxic, Oxidative, Genotoxic, and Embryotoxic Perspectives. J Toxicol 2022; 2022:3775194. [DOI: 10.1155/2022/3775194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 11/20/2022] Open
Abstract
The tripeptide H-Gly-Pro-Glu-OH (GPE) and its analogs began to take much interest from scientists for developing effective novel molecules in the treatment of several disorders including Alzheimer’s disease, Parkinson’s disease, and stroke. The peptidomimetics of GPEs exerted significant biological properties involving anti-inflammatory, antiapoptotic, and anticancer properties. The assessments of their hematological toxicity potentials are critically required for their possible usage in further preclinical and clinical trials against a wide range of pathological conditions. However, there is so limited information on the safety profiling of GPE and its analogs on human blood tissue from cytotoxic, oxidative, and genotoxic perspectives. And, their embryotoxicity potentials were not investigated yet. Therefore, in this study, measurements of mitochondrial viability (using MTT assay) and lactate dehydrogenase (LDH) release as well as total antioxidant capacity (TAC) assays were performed on cultured human whole blood cells after treatment with GPE and its three novel peptidomimetics for 72 h. Sister chromatid exchange (SCE), micronucleus (MN), and 8-oxo-2-deoxyguanosine (8-OH-dG) assays were performed for determining the genotoxic damage potentials. In addition, the nuclear division index (NDI) was figured out for revealing their cytostatic potentials. Embryotoxicity assessments were performed on cultured human pluripotent NT2 embryonal carcinoma cells by MTT and LDH assays. The present results from cytotoxicity, oxidative, genotoxicity, and embryotoxicity testing clearly propounded that GPEs had good biosafety profiles and were trouble-free from the toxicological point of view. Noncytotoxic, antioxidative, nongenotoxic, noncytostatic, and nonembryotoxic features of GPE analogs are worthwhile exploring further and may exert high potentials for improving the development of novel disease-modifying agents.
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Tran YH, Huynh HK, Faas MM, de Vos S, Groen H. Antidepressant use during pregnancy and development of preeclampsia: A focus on classes of action and specific transporters/receptors targeted by antidepressants. J Psychiatr Res 2022; 146:92-101. [PMID: 34959164 DOI: 10.1016/j.jpsychires.2021.12.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The association between antidepressants and preeclampsia has been inconsistently reported. Given the compound-specific variable affinity for different transporters/receptors, their effect on preeclampsia risk could differ. Our study examined the risk of preeclampsia (and its subtypes) following exposure to different classes of antidepressants, also accounting for specific transporters/receptors targeted by antidepressants. METHODS We conducted a cohort study, combining data from the Netherlands Perinatal Registry and the PHARMO Database Network. Exposure to antidepressants was examined from conception to week 20 of gestation; extended use thereafter was also studied. Antidepressants were categorized according to classes [selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs) and other antidepressants] and according to target transporters/receptors. Women not using any antidepressants during 15 months before delivery were included as reference. RESULTS We included 2,103 exposed and 95,376 reference women. Preeclampsia occurred in 70 exposed women (15 early-onset, 55 late-onset) and in 2,582 reference women (387 early-onset, 2,195 late-onset). TCA monotherapy (214 women) was associated with an increased risk of preeclampsia (n = 15, RR 2.46, 95% CI 1.51-4.02) and late-onset preeclampsia (n = 12, RR 2.41, 95% CI 1.39-4.17, early-onset could not be evaluated). No association was detected with SSRIs, SNRIs and MAOIs. We did observe an increased risk of early-onset preeclampsia following exposure to 5-HT2A antagonizing antidepressants (6/405 women, excluding TCA users, RR 3.56, 95% CI 1.60-7.94). CONCLUSIONS Our results support an increased risk of preeclampsia and the late-onset subtype among TCA users. The association between 5-HT2A antagonists and the early-onset subtype needs to be interpreted with caution based on the relatively small number of exposed cases.
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Affiliation(s)
- Yen-Hao Tran
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713, AV, Groningen, the Netherlands; Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Ninh Kieu District, Can Tho, Viet Nam.
| | - Hieu K Huynh
- Department of Traumato-Orthopedics, European Hospital Georges Pompidou APHP, Paris, France; Department of International Relations, University of Medicine and Pharmacy at Ho Chi Minh City, District 5, Ho Chi Minh, Viet Nam
| | - Marijke M Faas
- Department of Pathology and Medical Biology, Division of Medical Biology, University of Groningen, University Medical Center Groningen, 9713, AV, Groningen, the Netherlands
| | - Stijn de Vos
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713, AV, Groningen, the Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, 9700, RB, Groningen, the Netherlands
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Larcin L, Lona M, Karakaya G, Van Espen A, Damase-Michel C, Kirakoya-Samadoulougou F. Using administrative healthcare database records to study trends in prescribed medication dispensed during pregnancy in Belgium from 2003 to 2017. Pharmacoepidemiol Drug Saf 2021; 30:1224-1232. [PMID: 34053137 DOI: 10.1002/pds.5299] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/28/2021] [Accepted: 05/27/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE The aim of this study was to describe trends in medication prescriptions dispensed during pregnancy in Belgium using administrative healthcare database records from a representative sample of the Belgian population. METHODS Pregnant women were identified with reimbursement codes associated with the delivery of a baby. Data were extracted for three study periods, each over 3 years: 2003-2005, 2009-2011, and 2015-2017. The age-standardized prevalence of dispensed medications during pregnancy were computed and logistic regression models were used to evaluate the trends in prevalence across the study periods. The most frequently dispensed medications were listed for each study period. RESULTS The study included 23 912 pregnancies. The age-standardized prevalence of pregnant women with at least one dispensed medication increased across the three study periods from 81.8.% to 89.3%. The median number and interquartile range of the different medications dispensed during pregnancy rose from 2 (1-6) to 3 (1-7) between the first and last study periods. In the 2015-2017 period, the most frequently dispensed medications during pregnancy included progesterone (25.5%), paracetamol (17.8%), and amoxicillin (17.1%). The data also showed an increasing trend for the dispensation of ibuprofen and ketorolac during pregnancy across the three study periods. CONCLUSIONS The prevalence of prescribed medications dispensed during pregnancy increased in Belgium from 2003 to 2017 with high proportion for Progesterone and Antibiotics. Utilization of certain nonsteroidal anti-inflammatory drugs (NSAIDs) increased between 2003 and 2017, despite recommendations to avoid them.
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Affiliation(s)
- Lionel Larcin
- Centre de recherche Epidémiologie, Biostatistiques, Recherche Clinique, School of Public Health, Université Libre de Bruxelles (U.L.B.), Bruxelles, Belgium
| | - Murielle Lona
- Agence Intermutualiste (IMA), Bruxelles, Belgium.,Service études des Mutualités Libres, Bruxelles, Belgium
| | - Güngör Karakaya
- Agence Intermutualiste (IMA), Bruxelles, Belgium.,Service études des Mutualités Libres, Bruxelles, Belgium
| | | | | | - Fati Kirakoya-Samadoulougou
- Centre de recherche Epidémiologie, Biostatistiques, Recherche Clinique, School of Public Health, Université Libre de Bruxelles (U.L.B.), Bruxelles, Belgium
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Tint A, Brown HK, Chen S, Lai MC, Tarasoff LA, Vigod SN, Parish S, Havercamp SM, Lunsky Y. Health characteristics of reproductive-aged autistic women in Ontario: A population-based, cross-sectional study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1114-1124. [PMID: 33467914 PMCID: PMC8089036 DOI: 10.1177/1362361320982819] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT While an increasing number of girls and women are being identified with autism, we know little about reproductive-aged autistic women's health. This study used administrative data from Ontario, Canada, to compare the health of reproductive-aged autistic women with non-autistic women. Overall, reproductive-aged autistic women had poorer health compared with non-autistic women, including increased rates of material deprivation, chronic medical conditions, psychiatric conditions, history of assault, and use of potentially teratogenic medications (i.e. drugs that can be harmful to the development of an embryo or fetus). These findings suggest that there is a need for health interventions tailored to the needs of reproductive-aged autistic women.
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Affiliation(s)
- Ami Tint
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Hilary K. Brown
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Women’s College Hospital and Research Institute, Toronto, Ontario, Canada
| | | | - Meng-Chuan Lai
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Brain and Mental Health and Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, University of Toronto, Toronto, Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Lesley A. Tarasoff
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Simone N. Vigod
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Women’s College Hospital and Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Susan Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
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Ceulemans M, Liekens S, Van Calsteren K, Allegaert K, Foulon V. Impact of a blended learning program on community pharmacists' barriers, knowledge, and counseling practice with regard to preconception, pregnancy and lactation. Res Social Adm Pharm 2020; 17:1242-1249. [PMID: 32952090 DOI: 10.1016/j.sapharm.2020.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 08/03/2020] [Accepted: 09/10/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Community pharmacists acknowledge to have an important role in providing pharmaceutical care during preconception, pregnancy and lactation. However, pharmacists' knowledge and counseling regarding this topic is still insufficient. Hence, educational initiatives are urgently needed. OBJECTIVES To assess the impact of a blended learning program ('intervention') on community pharmacists' barriers, knowledge, and counseling practice with regard to preconception, pregnancy and lactation. METHODS A pre-post study was performed in collaboration with 40 randomly selected pharmacies belonging to a large pharmacy chain in Belgium. All pharmacists employed in these pharmacies were eligible to participate in a blended learning program consisting of an e-learning and an on-site training day. Data were collected using online surveys, mystery shopping visits and pharmacy records. Pharmacy conversations were assessed on information gathering, dispensed product, and case-specific information. A retention knowledge test was completed 3-6 months after the intervention. RESULTS In total, 60 pharmacists completed the post-intervention surveys (response rate: 95%). The total number of barriers decreased after the intervention, while organizational barriers such as lack of privacy (73%) and lack of time (67%) became more prevalent. Pharmacists' short and long-term knowledge improved after the intervention (p ≤ 0.001), although knowledge declined again over time (p ≤ 0.001). During counseling, pharmacists more often spontaneously provided information about folic acid when dispensing a pregnancy test, and more often suggested the correct dose/dosage for the dispensed OTC-product against pregnancy-related nausea. However, poor information gathering, dosing errors and incomplete information were still observed. CONCLUSION The blended learning decreased pharmacists' barriers and improved their short- and long-term knowledge, while counseling practice only partially improved. Hence, the blended learning was insufficient to enhance pharmacists' information gathering competences and to fully implement pharmaceutical care services with regard to preconception, pregnancy and lactation.
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Affiliation(s)
- Michael Ceulemans
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium.
| | - Sophie Liekens
- Faculty of Pharmaceutical Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium.
| | - Kristel Van Calsteren
- Department of Obstetrics & Gynecology, University Hospital Gasthuisberg Leuven, Herestraat 49, B-3000 Leuven, Belgium; Department of Development and Regeneration, Woman and Child, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium.
| | - Karel Allegaert
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium; Department of Development and Regeneration, Woman and Child, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium; Department of Clinical Pharmacy, Erasmus MC, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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Tarasoff LA, Lunsky Y, Chen S, Guttmann A, Havercamp SM, Parish SL, Vigod SN, Carty A, Brown HK. Preconception Health Characteristics of Women with Disabilities in Ontario: A Population-Based, Cross-Sectional Study. J Womens Health (Larchmt) 2020; 29:1564-1575. [PMID: 32678692 DOI: 10.1089/jwh.2019.8273] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: There is growing recognition that preconception health, defined as the health of all reproductive-age individuals, impacts reproductive and perinatal outcomes. Although women with disabilities are becoming pregnant at increasing rates, little is known about their preconception health. Our objective was to describe the preconception health characteristics of women with physical, sensory, and intellectual/developmental disabilities and compare these characteristics with women without disabilities. Materials and Methods: We conducted a population-based cross-sectional study of 15- to 44-year-old women with physical (n = 253,184), sensory (n = 93,170), intellectual/developmental (n = 8,986), and multiple disabilities (n = 29,868), and women without these disabilities (n = 2,307,822) using Ontario health administrative data (2017-2018). We described preconception health variables related to social determinants of health, physical health status, psychosocial well-being, history of assault, medication use, and continuity of primary care and compared women with and without disabilities in crude and age-standardized analyses, with standardized differences >0.10 indicating clinically meaningful results. Results: Women with physical, sensory, intellectual/developmental, and multiple disabilities had poorer preconception health than women without disabilities. Disparities were pronounced for physical health status, psychosocial well-being, use of potentially teratogenic medications, and history of assault. Of all groups, women with intellectual/developmental disabilities had the greatest disparities. Conclusion: Further research is needed to identify contributors to poor preconception health among women with disabilities and to develop tailored preconception health interventions to meet their unique needs and experiences.
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Affiliation(s)
- Lesley A Tarasoff
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Canada.,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada
| | | | - Astrid Guttmann
- ICES, Toronto, Canada.,Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Susan L Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Women's College Hospital and Research Institute, Toronto, Canada
| | - Adele Carty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hilary K Brown
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Canada.,ICES, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Women's College Hospital and Research Institute, Toronto, Canada
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9
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Ceulemans M, Fortuin M, Van Calsteren K, Allegaert K, Foulon V. Prevalence and characteristics of pregnancy- and lactation-related calls to the National Poison Centre in Belgium: A retrospective analysis of calls from 2012 to 2017. J Eval Clin Pract 2020; 26:911-917. [PMID: 31298801 DOI: 10.1111/jep.13228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 12/23/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVE In the absence of a Teratology Information Service in Belgium, the National Poison Centre might act as a substitute centre for answering pregnancy- and lactation-related questions regarding medication use. The aim of this study was to define the prevalence and characteristics of pregnancy- and lactation-related calls to the National Poison Centre in Belgium, as well as the type of health products involved during these calls. METHOD A retrospective, descriptive study on pregnancy- and lactation-related calls involving health products received by the Belgian Poison Centre between January 2012 and December 2017 was performed. Health products were categorized as registered medicines or non-registered health products; medicines were further classified according to the Anatomical Therapeutic Chemical classification system. RESULTS The Poison Centre annually received about 361 calls related to pregnancy and lactation. Pregnant and lactating women mainly called the Poison Centre themselves in case of exposure, while relatives were the predominant type of caller when preventive information was requested. The Poison Centre was mostly contacted for information about medicines and especially for preventive questions during lactation. Many questions involved over-the-counter medicines such as paracetamol and ibuprofen. Given the safety issues related to some involved products (eg, ibuprofen, zolpidem, benzodiazepines, and pseudoephedrine), seeking for advice was justified. CONCLUSIONS The Belgian Poison Centre received almost daily calls from patients and health care professionals on medication exposure during pregnancy and lactation. These findings underline the importance of evidence-based counselling of pregnant and lactating women and should encourage health care professionals to engage themselves more actively when counselling on the rational use of medicines during pregnancy and lactation. The findings also contribute to the ongoing discussion to establish a Teratology Information Service in Belgium.
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Affiliation(s)
- Michael Ceulemans
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Marijke Fortuin
- Hospitaal Centrum van de basis Koningin Astrid, National Poison Centre, Brussel, Belgium
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium.,Department of Development and Regeneration, Women 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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10
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Donald S, Sharples K, Barson D, Horsburgh S, Parkin L. Prescription medicines with potential for foetal harm: dispensing before and during pregnancy in New Zealand, 2005–2015. Eur J Clin Pharmacol 2020; 76:887-896. [DOI: 10.1007/s00228-020-02868-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/26/2020] [Indexed: 01/19/2023]
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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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Raichand S, Pearson SA, Zoega H, Buckley NA, Havard A. Utilisation of teratogenic medicines before and during pregnancy in Australian women. Aust N Z J Obstet Gynaecol 2019; 60:218-224. [PMID: 31397495 DOI: 10.1111/ajo.13044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/06/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Given the potential hazards of teratogenic medicines, to a fetus exposed in utero, monitoring their use around pregnancy is imperative. AIM To measure utilisation of teratogenic medicines (Therapeutic Goods Administration's category D or X) in women who gave birth in New South Wales, Australia, during pregnancy and the 24 months prior. MATERIALS AND METHODS We used linked population-based datasets including dispensing and perinatal data for all deliveries in NSW between 2005 and 2012. We included pregnancies among concessional beneficiaries only, with complete ascertainment of dispensing claims. Pre-pregnancy and during-pregnancy periods were based on birth dates and gestational age. We determined prevalence of exposure using percent of pregnancies in which women had at least one dispensed teratogenic medicine in three-month time periods. RESULTS The study included 191 588 pregnancies (145 419 women). Prevalence of exposure to D/X medicines anytime during pregnancy was 2.0% (<20 pregnancies category X), decreasing from pre-pregnancy (3.8-6.0%) to first trimester (1.5%), further decreasing in second and third trimesters (0.8% and 0.6% respectively). We observed large reductions in antibiotic prevalence but only modest reductions for psychotropics and antilipidemic agents (all category D). Our results suggest higher use of potentially teratogenic medicines (category D) than those strictly contraindicated for use (category X), during pregnancy. Overall, use was higher in the first trimester than the rest of pregnancy. The high prevalence of potentially contraindicated psychotropics in all three trimesters may suggest a higher benefit-to-risk ratio and warrants future research focusing on the reasons for their prescribing to pregnant women.
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Affiliation(s)
- Smriti Raichand
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Sydney, New South Wales, Australia
| | - Helga Zoega
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Sydney, New South Wales, Australia.,Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Nicholas A Buckley
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Alys Havard
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Sydney, New South Wales, Australia
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Ceulemans M, Chaar R, Van Calsteren K, Allegaert K, Foulon V. Arabic-speaking pregnant women with a migration background: A vulnerable target group for prenatal counseling on medicines. Res Social Adm Pharm 2019; 16:377-382. [PMID: 31221568 DOI: 10.1016/j.sapharm.2019.06.004] [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: 03/16/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The diversity of the European population increased over the last decades due to migration influences. It is obvious that pregnant women with a migration background also need access to the healthcare system of their host country. Nevertheless, pregnancies among women with a migration background may be even more challenging due to a higher prevalence of adverse pregnancy outcomes, higher risk of vitamin deficiencies or lower intake of folic acid. These issues reinforce the need for effective counseling by healthcare professionals (HCPs). OBJECTIVES To explore the experiences of Arabic-speaking pregnant women with a migration background living in Belgium regarding their communication with HCPs, as well as their perceptions towards HCPs and the use of healthcare products during pregnancy. METHODS Semi-structured interviews with Arabic-speaking pregnant women were conducted between February-July 2017 using purposive and snowball sampling. An empirically based conceptual framework, grounded in the interview data, was developed prior to content analysis and coding with Nvivo 11. RESULTS In total, 17 interviews were conducted. Most women reported that they were suffering from the language barrier, which hindered their communication with HCPs and had undesirable consequences on their treatment and medication use. Communication was largely affected by the presence of interpreters. During pregnancy, a high threshold to use medicines and a preference for natural remedies was observed. CONCLUSION Arabic-speaking pregnant women with a migration background living in Belgium are a vulnerable target group for prenatal counseling on medicines. Besides early dectection and willingness to help these women, HCPs should refer them to appropriate and understandable online sources and provide evidence-based information about the use of healthcare products during pregnancy. To facilitate the patient-HCP communication, strategies are further needed to stimulate these women to learn a national language and to increase their social integration.
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Affiliation(s)
- Michael Ceulemans
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Raneem Chaar
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Kristel Van Calsteren
- Department of Obstetrics & Gynecology, University Hospital Gasthuisberg Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Development and Regeneration, Woman and Child, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Karel Allegaert
- Department of Development and Regeneration, Woman and Child, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Pediatrics, Erasmus MC Sophia Children's Hospital, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands.
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
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Abstract
Importance We have performed a systematic search to summarize the role of statins for preventing and treating severe preeclampsia. Objective The aim of this study was to examine whether pravastatin is a useful and safe alternative for treating preeclampsia during pregnancy. Evidence Acquisition A systematic MEDLINE (PubMed) search was performed (1979 to June 2017), which was restricted to articles published in English, using the relevant key words of "statins," "pregnancy," "preeclampsia," "obstetrical antiphospholipid syndrome," and "teratogenicity." Results The initial search provided 296 articles. Finally, 146 articles were related to the use of statins during pregnancy, regarding their effect on the fetus and the treatment of preeclampsia. Ten studies were related to in vitro studies, 25 in animals, and 24 in humans (13 case report series and 11 cohort studies). We found 84 studies on reviews of such guidelines on cardiovascular disease (35 studies), use of statins in the antiphospholipid syndrome (25 studies), statin's specific use during pregnancy (13 studies), or preeclampsia treatment (11 studies). Conclusions Although the studies are of poor quality, the rate of major congenital abnormalities in the newborn exposed to statins during pregnancy is no higher than the expected when compared with overall risk population. The review shows a potential beneficial role of statins in preventing and treating severe preeclampsia that needs to be evaluated through well-designed clinical trials. Relevance This update could influence positively the clinical practice, giving an alternative therapy for clinicians who treat preeclampsia, particularly in severe cases.
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Samavati R, Ducza E, Hajagos-Tóth J, Gaspar R. Herbal laxatives and antiemetics in pregnancy. Reprod Toxicol 2017; 72:153-158. [DOI: 10.1016/j.reprotox.2017.06.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/24/2017] [Accepted: 06/05/2017] [Indexed: 11/27/2022]
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Andrade SE, Bérard A, Nordeng HME, Wood ME, van Gelder MMHJ, Toh S. Administrative Claims Data Versus Augmented Pregnancy Data for the Study of Pharmaceutical Treatments in Pregnancy. CURR EPIDEMIOL REP 2017; 4:106-116. [PMID: 29399433 PMCID: PMC5780544 DOI: 10.1007/s40471-017-0104-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose of Review Administrative claims databases, which collect reimbursement-related information generated from healthcare encounters, are increasingly used to evaluate medication safety in pregnancy. We reviewed the strengths and limitations of claims-only databases and how other data sources may be used to improve the accuracy and completeness of information critical for studying medication safety in pregnancy. Recent Findings Research on medication safety in pregnancy requires information on pregnancy episodes, mother-infant linkage, medication exposure, gestational age, maternal and birth outcomes, confounding factors, and (in some studies) long-term follow-up data. Claims data reliably identifies live births and possibly other pregnancies. It allows mother-infant linkage and has prospectively collected prescription medication information. Its diagnosis and procedure information allows estimation of gestational age. It captures maternal medical conditions but generally has incomplete data on reproductive and lifestyle factors. It has information on certain, typically short-term maternal and infant outcomes that may require chart review confirmation. Other data sources including electronic health records and birth registries can augment claims data or be analyzed alone. Interviews, surveys, or biological samples provide additional information. Nationwide and regional birth and pregnancy registries, such as those in several European and North American countries, generally contain more complete information essential for pregnancy research compared to claims-only databases. Summary Claims data offers several advantages in medication safety in pregnancy research. Its limitations can be partially addressed by linking it with other data sources or supplementing with primary data collection. Rigorous assessment of data quality and completeness is recommended regardless of data sources.
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Affiliation(s)
- Susan E Andrade
- 1Meyers Primary Care Institute, Fallon Community Health Plan, Reliant Medical Group, University of Massachusetts Medical School, 425 North Lake Avenue, Worcester, MA 01605 USA
| | - Anick Bérard
- 2Faculty of Pharmacy, and CHU Ste-Justine Research Center, University of Montreal, 3175 Côte-Ste-Catherine, Montreal, QC H3T 1C5 Canada
| | - Hedvig M E Nordeng
- 3Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box 1068, Blindern, 0316 Oslo, Norway.,4Department of Child Health, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, 0403 Oslo, Norway
| | - Mollie E Wood
- 3Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box 1068, Blindern, 0316 Oslo, Norway
| | - Marleen M H J van Gelder
- 5Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.,6Radboud REshape Innovation Center, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Sengwee Toh
- 7Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215 USA
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Effects of Pharmacological Agents on Human Amniotic Fluid-Derived Stem Cells in Culture. Stem Cells Dev 2016; 25:1570-1579. [DOI: 10.1089/scd.2016.0141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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