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Li L, Wang K, Wang M, Tao J, Li X, Liu Z, Li N, Qiu X, Wei H, Lin Y, He Y, Deng Y, Kang H, Li Y, Yu P, Wang Y, Zhu J, Liu H. The maternal drug exposure birth cohort (DEBC) in China. Nat Commun 2024; 15:5312. [PMID: 38906856 PMCID: PMC11192739 DOI: 10.1038/s41467-024-49623-0] [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: 03/06/2023] [Accepted: 06/12/2024] [Indexed: 06/23/2024] Open
Abstract
Drug exposure during pregnancy lacks global fetal safety data. The maternal drug exposure birth cohort (DEBC) study, a prospective longitudinal investigation, aims to explore the correlation of maternal drug exposure during pregnancy with pregnancy outcomes, and establish a human biospecimen biobank. Here we describe the process of establishing DEBC and show that the drug exposure rate in the first trimester of pregnant women in DEBC (n = 112,986) is 30.70%. Among the drugs used, dydrogesterone and progesterone have the highest exposure rates, which are 11.97% and 10.82%, respectively. The overall incidence of adverse pregnancy outcomes is 13.49%. Dydrogesterone exposure during the first trimester is correlated with higher incidences of stillbirth, preterm birth, low birth weight, and birth defects, along with a lower incidence of miscarriage/abortion. Due to the limitations of this cohort study, causative conclusions cannot be drawn. Further follow-up and in-depth data analysis are planned for future studies.
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Affiliation(s)
- Lu Li
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ke Wang
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Meixian Wang
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jing Tao
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohong Li
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhen Liu
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Nana Li
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoxia Qiu
- The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Hongwei Wei
- The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Yuan Lin
- Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian, China
| | - Yuan He
- National Research Institute for Family Planning, National Human Genetic Resource Center, Beijing, China
| | - Ying Deng
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Kang
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuting Li
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ping Yu
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Yanping Wang
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Jun Zhu
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Hanmin Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
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Locatelli A, Ornaghi S, Terzaghi A, Belleudi V, Fortinguerra F, Poggi FR, Perna S, Trotta F. Antidiabetic Therapy during Pregnancy: The Prescription Pattern in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7139. [PMID: 38063570 PMCID: PMC10706431 DOI: 10.3390/ijerph20237139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/26/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023]
Abstract
Pregestational and gestational diabetes mellitus are relevant complications of pregnancy, and antidiabetic drugs are prescribed to obtain glycemic control and improve perinatal outcomes. The objective of this study was to describe the prescription pattern of antidiabetics before, during and after pregnancy in Italy and to evaluate its concordance with the Italian guideline on treatment of diabetes mellitus. A multi-database cross-sectional population study using a Common Data Model was performed. In a cohort of about 450,000 women, the prescribing profile of antidiabetics seemed to be in line with the Italian guideline, which currently does not recommend the use of oral antidiabetics and non-insulin injection, even if practice is still heterogeneous (up to 3.8% in the third trimester used oral antidiabetics). A substantial variability in the prescription pattern was observed among the Italian regions considered: the highest increase was registered in Tuscany (4.2%) while the lowest was in Lombardy (1.5%). Women with multiple births had a higher proportion of antidiabetic prescriptions than women with singleton births both in the preconception period and during pregnancy (1.3% vs. 0.7%; 3.4% vs. 2.6%) and used metformin more frequently. The consumption of antidiabetics in foreign women was higher than Italians (second trimester: 1.8% vs. 0.9%, third trimester: 3.6% vs. 1.8%).
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Affiliation(s)
- Anna Locatelli
- School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (A.L.); (A.T.)
| | - Sara Ornaghi
- School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (A.L.); (A.T.)
| | - Alessandra Terzaghi
- School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (A.L.); (A.T.)
| | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, 00147 Rome, Italy; (V.B.); (F.R.P.)
| | | | - Francesca Romana Poggi
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, 00147 Rome, Italy; (V.B.); (F.R.P.)
| | - Serena Perna
- Italian Medicines Agency (AIFA), 00187 Rome, Italy; (F.F.); (S.P.); (F.T.)
| | - Francesco Trotta
- Italian Medicines Agency (AIFA), 00187 Rome, Italy; (F.F.); (S.P.); (F.T.)
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Fortinguerra F, Belleudi V, Poggi FR, Perna S, Bortolus R, Donati S, D’Aloja P, Da Cas R, Clavenna A, Locatelli A, Addis A, Davoli M, Trotta F. Monitoring medicine prescriptions before, during and after pregnancy in Italy. PLoS One 2023; 18:e0287111. [PMID: 37319236 PMCID: PMC10270638 DOI: 10.1371/journal.pone.0287111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/29/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The use of medications during pregnancy is a common event worldwide. Monitoring medicine prescriptions in clinical practice is a necessary step in assessing the impact of therapeutic choices in pregnant women as well as the adherence to clinical guidelines. The aim of this study was to provide prevalence data on medication use before, during and after pregnancy in the Italian population. METHODS A retrospective prevalence study using administrative healthcare databases was conducted. A cohort of 449,012 pregnant women (15-49 years) residing in eight Italian regions (59% of national population), who delivered in 2016-2018, were enrolled. The prevalence of medication use was estimated as the proportion (%) of pregnant women with any prescription. RESULTS About 73.1% of enrolled women received at least one drug prescription during pregnancy, 57.1% in pre-pregnancy and 59.3% in postpartum period. The prevalence of drug prescriptions increased with maternal age, especially during the 1st trimester of pregnancy. The most prescribed medicine was folic acid (34.6%), followed by progesterone (19%), both concentrated in 1st trimester of pregnancy (29.2% and 14.8%, respectively). Eight of the top 30 most prescribed medications were antibiotics, whose prevalence was higher during 2nd trimester of pregnancy in women ≥ 40 years (21.6%). An increase in prescriptions of anti-hypertensives, antidiabetics, thyroid hormone and heparin preparations was observed during pregnancy; on the contrary, a decrease was found for chronic therapies, such as anti-epileptics or lipid-modifying agents. CONCLUSIONS This study represents the largest and most representative population-based study illustrating the medication prescription patterns before, during and after pregnancy in Italy. The observed prescriptive trends were comparable to those reported in other European countries. Given the limited information on medication use in Italian pregnant women, the performed analyses provide an updated overview of drug prescribing in this population, which can help to identify critical aspects in clinical practice and to improve the medical care of pregnant and childbearing women in Italy.
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Affiliation(s)
| | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | | | - Renata Bortolus
- Directorate General for Preventive Health–Office 9, Ministry of Health, Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità –Italian National Institute of Health, Rome, Italy
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità –Italian National Institute of Health, Rome, Italy
| | - Roberto Da Cas
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità –Italian National Institute of Health, Rome, Italy
| | - Antonio Clavenna
- Laboratory for Pharmacoepidemiology, Department of Public Health, IRCCS–Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Anna Locatelli
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy
| | - Antonio Addis
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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Belleudi V, Rosa AC, Finocchietti M, Poggi FR, Marino ML, Massari M, Spila Alegiani S, Masiero L, Ricci A, Bedeschi G, Puoti F, Cardillo M, Pierobon S, Nordio M, Ferroni E, Zanforlini M, Piccolo G, Leone O, Ledda S, Carta P, Garau D, Lucenteforte E, Davoli M, Addis A. An Italian multicentre distributed data research network to study the use, effectiveness, and safety of immunosuppressive drugs in transplant patients: Framework and perspectives of the CESIT project. Front Pharmacol 2022; 13:959267. [PMID: 36188626 PMCID: PMC9521186 DOI: 10.3389/fphar.2022.959267] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022] Open
Abstract
The goal of post-transplant immunosuppressive drug therapy is to prevent organ rejection while minimizing drug toxicities. In clinical practice, a multidrug approach is commonly used and involves drugs with different mechanisms of action, including calcineurin inhibitors (CNI) (tacrolimus or cyclosporine), antimetabolite (antimet) (mycophenolate or azathioprine), inhibitors of mechanistic target of rapamycin (mTOR) (sirolimus or everolimus), and/or steroids. Although evidence based on several randomized clinical trials is available, the optimal immunosuppressive therapy has not been established and may vary among organ transplant settings. To improve the knowledge on this topic, a multiregional research network to Compare the Effectiveness and Safety of Immunosuppressive drugs in Transplant patients (CESIT) has been created with the financial support of the Italian Medicines Agency. In this article, we describe the development of this network, the framework that was designed to perform observational studies, and we also give an overview of the preliminary results that we have obtained. A multi-database transplant cohort was enrolled using a common data model based on healthcare claims data of four Italian regions (Lombardy, Veneto, Lazio, and Sardinia). Analytical datasets were created using an open-source tool for distributed analysis. To link the National Transplant Information System to the regional transplant cohorts, a semi-deterministic record linkage procedure was performed. Overall, 6,914 transplant patients from 2009–19 were identified: 4,029 (58.3%) for kidney, 2,219 (32.1%) for liver, 434 (6.3%) for heart, and 215 (3.1%) for lung. As expected, demographic and clinical characteristics showed considerable variability among organ settings. Although the triple therapy in terms of CNI + antimet/mTOR + steroids was widely dispensed for all settings (63.7% for kidney, 33.5% for liver, 53.3% for heart, and 63.7% for lung), differences in the active agents involved were detected. The CESIT network represents a great opportunity to study several aspects related to the use, safety, and effectiveness of post-transplant maintenance immunosuppressive therapy in real practice.
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Affiliation(s)
- Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
- *Correspondence: Valeria Belleudi,
| | | | | | | | | | - Marco Massari
- National Center for Drug Research and Evaluation, Istituto Superiore Di Sanità, Rome, Italy
| | | | - Lucia Masiero
- Italian National Transplant Center—Istituto Superiore Di Sanità, Rome, Italy
| | - Andrea Ricci
- Italian National Transplant Center—Istituto Superiore Di Sanità, Rome, Italy
| | - Gaia Bedeschi
- Italian National Transplant Center—Istituto Superiore Di Sanità, Rome, Italy
| | - Francesca Puoti
- Italian National Transplant Center—Istituto Superiore Di Sanità, Rome, Italy
| | - Massimo Cardillo
- Italian National Transplant Center—Istituto Superiore Di Sanità, Rome, Italy
| | | | | | | | | | | | | | - Stefano Ledda
- General Directorate for Health, Sardinia Region, Italy
| | - Paolo Carta
- General Directorate for Health, Sardinia Region, Italy
| | | | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Antonio Addis
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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D’Aloja P, Da Cas R, Belleudi V, Fortinguerra F, Poggi FR, Perna S, Trotta F, Donati S. Drug Prescriptions among Italian and Immigrant Pregnant Women Resident in Italy: A Cross-Sectional Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074186. [PMID: 35409869 PMCID: PMC8998753 DOI: 10.3390/ijerph19074186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023]
Abstract
Ensuring drug safety for pregnant women through prescription drug monitoring is essential. The aim of this study was to describe the prescription pattern of medicines among pregnant immigrant women from countries with high migratory pressure (HMPCs) compared to pregnant Italian women. The prevalence of drug prescriptions among the two study populations was analysed through record linkage procedures applied to the administrative databases of eight Italian regions, from 2016 to 2018. The overall prevalence of drug prescription was calculated considering all women who received at least one prescription during the study period. Immigrants had a lower prevalence of drug prescriptions before (51.0% vs. 58.6%) and after pregnancy (55.1% vs. 60. 3%). Conversely, during pregnancy, they obtained a slightly higher number of prescriptions (74.9% vs. 72.8%). The most prescribed class of drugs was the blood and haematopoietic organs category (category ATC B) (56.4% vs. 45.9%, immigrants compared to Italians), followed by antimicrobials (31.3% vs. 33.7%). Most prescriptions were appropriate, while folic acid administration 3 months before conception was low for both study groups (3.9% immigrants and 6.2% Italians). Progesterone seemingly was prescribed against early pregnancy loss, more frequently among Italians (16.5% vs. 8.1% immigrants). Few inappropriate medications were prescribed among antihypertensives, statins and anti-inflammatory drugs in both study groups.
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Affiliation(s)
- Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità (National Institute of Health), 00161 Rome, Italy;
- Correspondence:
| | - Roberto Da Cas
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), 00161 Rome, Italy;
| | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, 00145 Rome, Italy; (V.B.); (F.R.P.)
| | - Filomena Fortinguerra
- HTA & Pharmaceutical Economy Division, Italian Medicines Agency (AIFA), 00187 Rome, Italy; (F.F.); (S.P.); (F.T.)
| | - Francesca Romana Poggi
- Department of Epidemiology, Lazio Regional Health Service, 00145 Rome, Italy; (V.B.); (F.R.P.)
| | - Serena Perna
- HTA & Pharmaceutical Economy Division, Italian Medicines Agency (AIFA), 00187 Rome, Italy; (F.F.); (S.P.); (F.T.)
| | - Francesco Trotta
- HTA & Pharmaceutical Economy Division, Italian Medicines Agency (AIFA), 00187 Rome, Italy; (F.F.); (S.P.); (F.T.)
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità (National Institute of Health), 00161 Rome, Italy;
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