Drug prescribing during pregnancy in a central region of Italy, 2008-2012

Abstract

BackgroundDrug consumption during pregnancy is a matter of concern, especially regarding drugs known or suspected to be teratogens. Little is known about drug use in pregnant women in Italy. The present study is aimed at examining the prevalence, and to detect potential inappropriateness of drug prescribing among pregnant women in Latium, a region of central Italy.MethodsThis retrospective study was conducted on a cohort of women aged 18-45 years who delivered between 2008 and 2012 in public hospitals. Women were enrolled through the Regional Birth Register. After linking the regional Health Information Systems and the Regional Drug Claims Register, women’s clinical data and prescribed medications were analyzed. Italian Medicine Agency (AIFA) and US Food and Drug Administration (FDA) evidence were used to investigate inappropriate prescribing and teratogenic risk.ResultsExcluding vitamins and minerals, 80.6% (n = 153,079) of the women were prescribed at least one drug during pregnancy, with an average of 4.6 medications per pregnancy. Drugs for blood and hematopoietic organs were the most commonly prescribed (53.0%,), followed by anti-infectives for systemic use (50.7%). Among the inappropriate prescriptions, progestogen supplementation was given in 20.1% of pregnancies; teratogen drugs were prescribed in 0.8%, mostly angiotensin co-enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) (0.3%).ConclusionsIn Latium, drugs are widely used in pregnancy. Prescriptions of inappropriate drugs are observed in more than a fifth of pregnancies, and teratogens are still used, despite their known risk. Continuous updates of information provided to practitioners and an increased availability of information to women might reduce inappropriate prescribing.

An algorithm to identify pregnancies in BIFAP Primary Care database in Spain: Results from a cohort of 155 419 pregnancies

“…In terms of drug utilization during first trimester, the most commonly prescribed drugs were analgesics (with special attention to paracetamol) and antibiotics, in line with results of previous studies evaluating drug use during pregnancy . When looking at the secular trends during the study period, we observed a trend towards an increase of overall prescription rates, similar to other studies .…”

“…As previously reported, in the current study, the use of psychotropics suffered a marked decline within the first trimester compared with pre‐pregnancy period and a slightly decreased in the first trimester during the studied period, with the exception of antiepileptics . Still, we observed a higher proportion of women receiving at least one prescription of benzodiazepines (BZD) during the first trimester than expected . In Spain, there has been an overall increased on BZD prescriptions in the last decade, with an annual increase of 2% to 3% which is also reflected in this specific population.…”

“…The most frequent drugs used were indicated for pain conditions, heartburn, and upper respiratory disorders. Of note, several studies have found an annual increase of prescribing drugs during pregnancy in the last decade with special focus to antidepressants, thyroid hormones, and opioids among others …”

Drug therapy during pregnancy

“…Furthermore, the average number of medications used anytime in pregnancy increased two-fold during that period 2 . More recent research from different countries has found that medications are widely used during pregnancy, with the prevalence of using at least one drug ranging from 60 to 90 percent, excluding vitamins and minerals [3][4][5] .…”

Fertility treatment and oral contraceptive discontinuation for identification of pregnancy planning in routinely collected health data – an application to analgesic and antibiotic utilisation

“…In routinely collected health data, where study samples are more representative of the underlying population, information on pregnancy intention is typically unavailable. Therefore, studies of prescription drug utilisation or safety usually lack information on pregnancy intention [6][7][8]. Further, for pregnancies to appear in routinely collected data and be identified in studies, they need to proceed beyond a certain point, for example week 12 [7], or end in live births [6].…”