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Tiani KA, Arenaz CM, Spill MK, Foster MJ, Davis JS, Bailey RL, Field MS, Stover PJ, MacFarlane AJ. The use of ginger bioactive compounds in pregnancy: an evidence scan and umbrella review of existing meta-analyses. Adv Nutr 2024:100308. [PMID: 39343171 DOI: 10.1016/j.advnut.2024.100308] [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: 05/09/2024] [Revised: 08/16/2024] [Accepted: 09/11/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Ginger is a commonly used nonpharmacological treatment for pregnancy-related symptoms including nausea and vomiting, inflammation, and gastrointestinal dysfunction. Determining the efficacy of ginger is particularly important during pregnancy and lactation when maternal and neonatal detrimental effects may be a concern. OBJECTIVE This evidence scan and umbrella review aimed to assess the extent and quality of the evidence regarding the effectiveness and safety of using dietary preparations of ginger during pregnancy and lactation. METHODS We searched MEDLINE, Embase, CAB Abstracts, and International Pharmaceutical Abstracts up to December 20th 2023 to identify maternal and neonatal outcomes associated with ginger use during pregnancy or lactation compared to placebo or conventional medicines. Outcomes for which a meta-analysis (MA) of intervention studies was identified were synthesized in an umbrella review. The AMSTAR-2 tool was used to critically appraise the reviews. The percent overlap in primary studies was calculated overall and pairwise for each included MA. Data extracted from each MA included the summary estimate of the effect of ginger, the formulation of the ginger treatment, gestational timepoint at intervention, population enrolled in the study, type of intervention, comparator intervention, and number of study participants. RESULTS The evidence scan identified 90 articles relevant to ginger use during pregnancy and lactation. Seven MAs of ginger use for treating nausea and vomiting of pregnancy reported 22 independent studies with a 49% study overlap among them. The majority of the MAs found a significant positive effect of ginger on the improvement of nausea in pregnancy compared to placebo, or equivalence to conventional treatments, and no evidence of significant adverse effects. The quality of the MAs ranged from critically low to low. CONCLUSIONS The evidence suggests that ginger is effective at reducing nausea in pregnancy; however, the included studies contained substantial heterogeneity and were of low quality. STATEMENT OF SIGNIFICANCE Despite common use of dietary ginger preparations among pregnant populations, recent umbrella reviews of ginger use have not focused on the potential health outcomes of ginger consumption in this vulnerable population.
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Affiliation(s)
- Kendra A Tiani
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, TX, USA
| | - Cristina M Arenaz
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, TX, USA
| | - Maureen K Spill
- Texas A&M Agriculture, Food and Nutrition Evidence Center, Fort Worth, TX, USA
| | - Margaret J Foster
- Center for Systematic Reviews and Evidence Syntheses, Texas A&M University, College Station, TX, USA
| | - Julie S Davis
- Texas A&M Agriculture, Food and Nutrition Evidence Center, Fort Worth, TX, USA
| | - Regan L Bailey
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, TX, USA; Department of Nutrition, Texas A&M University, College Station, TX, USA
| | - Martha S Field
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Patrick J Stover
- Department of Nutrition, Texas A&M University, College Station, TX, USA; Department of Biochemistry and Biophysics, Texas A&M University, College Station, TX, USA
| | - Amanda J MacFarlane
- Texas A&M Agriculture, Food and Nutrition Evidence Center, Fort Worth, TX, USA; Department of Nutrition, Texas A&M University, College Station, TX, USA.
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Petersen JM, Kahrs JC, Adrien N, Wood ME, Olshan AF, Smith LH, Howley MM, Ailes EC, Romitti PA, Herring AH, Parker SE, Shaw GM, Politis MD. Bias analyses to investigate the impact of differential participation: Application to a birth defects case-control study. Paediatr Perinat Epidemiol 2024; 38:535-543. [PMID: 38102868 PMCID: PMC11301528 DOI: 10.1111/ppe.13026] [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: 09/21/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Certain associations observed in the National Birth Defects Prevention Study (NBDPS) contrasted with other research or were from areas with mixed findings, including no decrease in odds of spina bifida with periconceptional folic acid supplementation, moderately increased cleft palate odds with ondansetron use and reduced hypospadias odds with maternal smoking. OBJECTIVES To investigate the plausibility and extent of differential participation to produce effect estimates observed in NBDPS. METHODS We searched the literature for factors related to these exposures and participation and conducted deterministic quantitative bias analyses. We estimated case-control participation and expected exposure prevalence based on internal and external reports, respectively. For the folic acid-spina bifida and ondansetron-cleft palate analyses, we hypothesized the true odds ratio (OR) based on prior studies and quantified the degree of exposure over- (or under-) representation to produce the crude OR (cOR) in NBDPS. For the smoking-hypospadias analysis, we estimated the extent of selection bias needed to nullify the association as well as the maximum potential harmful OR. RESULTS Under our assumptions (participation, exposure prevalence, true OR), there was overrepresentation of folic acid use and underrepresentation of ondansetron use and smoking among participants. Folic acid-exposed spina bifida cases would need to have been ≥1.2× more likely to participate than exposed controls to yield the observed null cOR. Ondansetron-exposed cleft palate cases would need to have been 1.6× more likely to participate than exposed controls if the true OR is null. Smoking-exposed hypospadias cases would need to have been ≥1.2 times less likely to participate than exposed controls for the association to falsely appear protective (upper bound of selection bias adjusted smoking-hypospadias OR = 2.02). CONCLUSIONS Differential participation could partly explain certain associations observed in NBDPS, but questions remain about why. Potential impacts of other systematic errors (e.g. exposure misclassification) could be informed by additional research.
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Affiliation(s)
- Julie M. Petersen
- Division for Surveillance, Research, and Promotion of Perinatal Health, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Jacob C. Kahrs
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nedghie Adrien
- Division for Surveillance, Research, and Promotion of Perinatal Health, Massachusetts Department of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Mollie E. Wood
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew F. Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Louisa H. Smith
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
- Roux Institute, Northeastern University, Portland, Maine, USA
| | - Meredith M. Howley
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
| | - Elizabeth C. Ailes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul A. Romitti
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Amy H. Herring
- Department of Statistical Science, Duke University, Durham, North Carolina, USA
| | - Samantha E. Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Gary M. Shaw
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Maria D. Politis
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Mercer AH, MacDuffie KE, Weiss EM, Johnson A, Dager SR, Kleinhans N. Interpersonal Influences on the Choice to Treat Nausea during Pregnancy with Medication or Cannabis. Am J Perinatol 2024; 41:e2941-e2951. [PMID: 37774747 DOI: 10.1055/a-2183-9013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
OBJECTIVE This study aimed to better understand the interpersonal influences on a pregnant individual's decision of how to treat nausea and vomiting during pregnancy using a qualitative approach. STUDY DESIGN A semistructured interview guide was developed to assess pregnancy symptoms, decision-making regarding treating nausea, and interpersonal influences on treatment decisions. Interviews were conducted with 17 individuals enrolled in a neuroimaging and behavioral study of prenatal exposure to cannabis who used medication and/or cannabis to treat symptoms associated with pregnancy. RESULTS Interviews revealed four groups of stakeholders who influenced participant decision-making: medical providers, partners, family, and friends. Influence was categorized as either positive, negative, neutral, or absent (if not discussed or participant chose not to disclose). Those in the medication group reported only positive or neutral feedback from friends, family, partners, and providers. In contrast, the cannabis group participants reported positive feedback from friends, mixed feedback from family and partners, and negative feedback from providers, which was often felt to be stigmatizing. Many in the cannabis group also reported varying feedback from different medical providers. While the cannabis group frequently reported eliciting feedback from friends, family, and partners, the medication group often did not. CONCLUSION Medication group participants reported entirely positive feedback from providers and often did not mention any feedback at all from partners, family, and friends. Cannabis group participants reported much more varied feedback, both positive and negative, from a variety of interpersonal contacts and sometimes decided to conceal their treatment choice after receiving or fearing negative feedback. We recommend further research into the health outcomes of pregnant patients who chose not to discuss their treatment decisions with providers, family, partners, or friends. We also suggest further study of possible reasons behind a lack of disclosure, including fear of stigma and/or legal consequences. KEY POINTS · Providers, partners, family, friends gave feedback.. · Medication group got positive feedback.. · Cannabis group stigmatized by providers.. · Cannabis group got mixed feedback..
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Affiliation(s)
- Amanda H Mercer
- Counselor Education Department, Portland State University, Portland, Oregon
| | - Katherine E MacDuffie
- Department of Pediatrics, Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, University of Washington, Seattle, Washington
| | - Elliott M Weiss
- Department of Pediatrics, Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, University of Washington, Seattle, Washington
| | - Allegra Johnson
- Department of Radiology, University of Washington, Seattle, Washington
| | - Stephen R Dager
- Department of Radiology, University of Washington, Seattle, Washington
| | - Natalia Kleinhans
- Department of Radiology, University of Washington, Seattle, Washington
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Schrager NL, Parker SE, Werler MM. The timing, duration, and severity of nausea and vomiting of pregnancy and adverse birth outcomes among controls without birth defects in the National Birth Defects Prevention Study. Birth Defects Res 2024; 116:e2334. [PMID: 38578229 DOI: 10.1002/bdr2.2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/31/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Nausea and vomiting of pregnancy (NVP) occurs in approximately 70% of pregnant people, with varying severity and duration. Treatments include pharmacologic and herbal/natural medications. The associations between NVP and birth outcomes, including preterm birth, small for gestational age (SGA), and low birth weight are inconclusive. OBJECTIVE To determine whether NVP and reported medications are associated with adverse birth outcomes. METHODS We used data from the population-based, multisite National Birth Defects Prevention Study (1997-2011) to evaluate whether self-reported NVP according to timing, duration, and severity or its specific treatments were associated with preterm birth, SGA, and low birth weight among controls without birth defects. Odds ratios (aOR) and 95% confidence intervals (CI) were adjusted for sociodemographic, reproductive, and medical factors. For any NVP, duration, treatment use, and severity score analyses, the comparison group was participants with no reported NVP. For timing analyses, the comparison group was women with no reported NVP in the same trimester of pregnancy. RESULTS Among 6018 participants, 4339 (72.1%) reported any NVP. Among those with NVP, moderate or severe symptoms were more common than mild symptoms. Any versus no NVP was not associated with any of the outcomes of interest. NVP in months 4-6 (aOR 1.21, 95% CI: 1.00, 1.47) and 7-9 (aOR 1.57, 95% CI: 1.22, 2.01) of pregnancy were associated with an increase in the risk of preterm birth. NVP lasting one trimester in duration was associated with decrease in risk of SGA (aOR: 0.74, 95% CI: 0.58, 0.95), and NVP present in every trimester of pregnancy had a 50% increase in risk of preterm birth (aOR: 1.50, 95% CI: 1.11, 2.05). For NVP in months 7-9 and preterm birth, ORs were elevated for moderate (aOR: 1.82, 95% CI: 1.26, 2.63), and severe (aOR: 1.53, 95% CI: 1.06, 2.19) symptoms. NVP was not significantly associated with low birth weight. Our analyses of medications were limited by small numbers, but none suggested increased risk of adverse outcomes associated with use of the medication. CONCLUSION Mild NVP and NVP limited to early pregnancy appear to have no effect or a small protective effect on birth outcomes. Long-lasting NVP, severe NVP, and NVP later in pregnancy may increase risk of preterm birth and SGA.
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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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Atoyebi S, Bunglawala F, Cottura N, Grañana-Castillo S, Montanha MC, Olagunju A, Siccardi M, Waitt C. Physiologically-based pharmacokinetic modelling of long-acting injectable cabotegravir and rilpivirine in pregnancy. Br J Clin Pharmacol 2024. [PMID: 38340019 DOI: 10.1111/bcp.16006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/25/2023] [Accepted: 01/06/2024] [Indexed: 02/12/2024] Open
Abstract
AIMS Long-acting cabotegravir and rilpivirine have been approved to manage HIV in adults, but data regarding safe use in pregnancy are limited. Physiologically-based pharmacokinetic (PBPK) modelling was used to simulate the approved dosing regimens in pregnancy and explore if Ctrough was maintained above cabotegravir and rilpivirine target concentrations (664 and 50 ng/mL, respectively). METHODS An adult PBPK model was validated using clinical data of cabotegravir and rilpivirine in nonpregnant adults. This was modified by incorporating pregnancy-induced metabolic and physiological changes. The pregnancy PBPK model was validated with data on oral rilpivirine and raltegravir (UGT1A1 probe substrate) in pregnancy. Twelve weeks' disposition of monthly and bimonthly dosing of long-acting cabotegravir and rilpivirine was simulated at different trimesters and foetal exposure was also estimated. RESULTS Predicted Ctrough at week 12 for monthly long-acting cabotegravir was above 664 ng/mL throughout pregnancy, but below the target in 0.5% of the pregnant population in the third trimester with bimonthly long-acting cabotegravir. Predicted Ctrough at week 12 for monthly and bimonthly long-acting rilpivirine was below 50 ng/mL in at least 40% and over 90% of the pregnant population, respectively, throughout pregnancy. Predicted medians (range) of cord-to-maternal blood ratios were 1.71 (range, 1.55-1.79) for cabotegravir and 0.88 (0.78-0.93) for rilpivirine between weeks 38 and 40. CONCLUSIONS Model predictions suggest that monthly long-acting cabotegravir could maintain antiviral efficacy throughout pregnancy, but that bimonthly administration may require careful clinical evaluation. Both monthly and bimonthly long-acting rilpivirine may not adequately maintain antiviral efficacy in pregnancy.
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Werler MM, Kerr SM, Ailes EC, Reefhuis J, Gilboa SM, Browne ML, Kelley KE, Hernandez-Diaz S, Smith-Webb RS, Garcia MH, Mitchell AA. Patterns of Prescription Medication Use during the First Trimester of Pregnancy in the United States, 1997-2018. Clin Pharmacol Ther 2023; 114:836-844. [PMID: 37356083 PMCID: PMC10949220 DOI: 10.1002/cpt.2981] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/16/2023] [Indexed: 06/27/2023]
Abstract
The objective of this analysis was to describe patterns of prescription medication use during pregnancy, including secular trends, with consideration of indication, and distributions of use within demographic subgroups. We conducted a descriptive secondary analysis using data from 9,755 women whose infants served as controls in two large United States case-control studies from 1997-2011 and 2014-2018. After excluding vitamin, herbal, mineral, vaccine, i.v. fluid, and topical products and over-the-counter medications, the proportion of women that reported taking at least one prescription medication in the first trimester increased over the study years, from 37% to 50% of women. The corresponding proportions increased with increasing maternal age and years of education, were highest for non-Hispanic White women (47%) and lowest for Hispanic women (24%). The most common indication for first trimester use of a medication was infection (12-15%). Increases were observed across the years for medications used for indications related to nausea/vomiting, depression/anxiety, infertility, thyroid disease, diabetes, and epilepsy. The largest relative increase in use among women was observed for medications to treat nausea/vomiting, which increased from 3.8% in the earliest years of the study (1997-2001) to 14.8% in 2014-2018, driven in large part by ondansetron use. Prescription medication use in the first trimester of pregnancy is common and increasing. Many medical conditions require treatments among pregnant women, often involving pharmacotherapy, which necessitates consideration of the risk and safety profiles for both mother and fetus.
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Affiliation(s)
- Martha M. Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Stephen M. Kerr
- Slone Epidemiology Center at Boston University School of Medicine, Boston, Massachusetts, USA
| | - Elizabeth C. Ailes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne M. Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marilyn L. Browne
- Birth Defects Registry, New York State Department of Health; Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Katherine E. Kelley
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | - Rashida S. Smith-Webb
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michelle Huezo Garcia
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Allen A. Mitchell
- Slone Epidemiology Center at Boston University School of Medicine, Boston, Massachusetts, USA
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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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van Gelder MMHJ, Nordeng H. Antiemetic Prescription Fills in Pregnancy: A Drug Utilization Study Among 762,437 Pregnancies in Norway. Clin Epidemiol 2021; 13:161-174. [PMID: 33664595 PMCID: PMC7924249 DOI: 10.2147/clep.s287892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/20/2021] [Indexed: 12/28/2022] Open
Abstract
Objective To determine antiemetic prescription fill patterns during pregnancy in Norway, with special focus on the use of ondansetron and recurrent use in subsequent pregnancies. Methods We conducted a population-based registry study based on data from the Medical Birth Registry of Norway linked to the Norwegian Prescription Database for 762,437 pregnancies >12 gestational weeks ending in live or non-live births between 2005 and 2017. Prescription fills of medications used for nausea and vomiting of pregnancy were summarized in treatment pathways to determine drug utilization patterns. Logistic regression analyses were used to estimate associations between maternal and pregnancy characteristics and antiemetic prescription fills. Results The prescription fill rate for antiemetic medication during pregnancy was 7.6%. However, prescription fill rates were 35.5% in the second pregnancy after filling an antiemetic prescription in the first pregnancy and 53.5% for women who filled antiemetic prescriptions in the previous 2 pregnancies. Among pregnancies with antiemetic prescription fills, 62.2% were dispensed metoclopramide, 28.2% meclizine, and 17.2% promethazine. First-line treatment started with monotherapy in 97.4% of these pregnancies, which was the only treatment received in 78.7%. Prescriptions for ondansetron were filled in 0.3% of pregnancies, with 76.9% being initially filled in the first trimester. Ondansetron as first-line prescription medication and/or use in the first trimester was associated with proxies for more severe nausea and vomiting of pregnancy, including a diagnosis of hyperemesis gravidarum, multiple gestations, a higher obstetric comorbidity index, and concomitant use of medication for gastroesophageal reflux disease and nervous system medications. Women who filled an antiemetic prescription in their first pregnancy were less likely to have subsequent pregnancies than women who did not fill an antiemetic prescription in their first pregnancy (OR 0.93, 95% CI 0.90–0.96). Conclusion Complex patterns of antiemetic prescription fills in pregnancy may mirror the challenge of optimal management of nausea and vomiting of pregnancy in clinical practice, especially for women with severe symptoms.
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Affiliation(s)
- Marleen M H J van Gelder
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud REshape Innovation Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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