Advertisement

Pharmaceutisch Weekblad

, Volume 14, Issue 2, pp 38–45 | Cite as

Handling of risk-bearing drugs during pregnancy

Do we choose less risky alternatives?
  • L. T. W. De Jong-Van den Berg
  • P. B. Van den Berg
  • F. M. Haaijer-Ruskamp
  • M. N. G. Dukes
  • H. Wesseling
Articles

Abstract

The drug use of nearly 2,000 pregnant women was evaluated at the level of the individual patient for the drugs belonging to the Australian risk categories B3, C and D. The pattern of changes in the use of these drugs is studied in terms of women who discontinue (d), continue (c) or begin (b) using the drug during pregnancy. The ratios d/(c+b) and d/b were the highest for the drugs belonging to the high-risk groups and the lowest for drugs from the low-risk categories. This suggests a congruence between theoretical knowledge and daily practice. Patients who had already been using a drug for a long time before pregnancy, more frequently continued using that drug than patients who had been using the drug only incidentally before. The described daily dose for the riskful drugs was approximately 20% lower in patients who started to use a drug during pregnancy compared to those who continued drug use. The data from this analysis indicate that the prescribing physician is generally aware of the possible risks of drug use during pregnancy. The d/(b+c) and d/b ratios are shown to be a good measure of prescribing behaviour in relation to pregnancy and can be used to compare knowledge of theory and daily practice.

Keywords

Analgesics Antibiotics Anticonvulsants Cardiovascular agents Drug utilization Pregnancy Prescriptions, drug Psychotropic drugs Teratogens 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Lenz W. Die Thalidomid Embryopathie. Dtsch Med Wochenschr 1961;86:2555.Google Scholar
  2. 2.
    Herbst AL, Ulfelder H, Poskanzer D. Adenocarcinoma of the vagina. N Engl J Med 1971;284:878–81.PubMedGoogle Scholar
  3. 3.
    Robert E, Lokvist E, Maugiere F. Valproate and spina bifida. Lancet 1984;2:1392.CrossRefGoogle Scholar
  4. 4.
    Rosa F. Isotretinoin dose and teratogenicity. Lancet 1987;2:1154.CrossRefGoogle Scholar
  5. 5.
    Laegreid L, Olegard R, Waldstrom J, et al. Abnormalities in children exposed to benzodiazepinesin utero. Lancet 1987;1:108.CrossRefGoogle Scholar
  6. 6.
    Australian Drug Evaluation Committee Medicines in Pregnancy. An Australian categorisation of risk. Canberra: Australian Publishing Service, 1989:1–48.Google Scholar
  7. 7.
    De Jong-van den Berg LTW, Van den Berg PB, Peters PWJ, Haaijer-Ruskamp FM. A study of drug utilization in pregnancy in the light of known risks: is there room for improvement? Int J Risk Safety Med 1990;1:91–105.Google Scholar
  8. 8.
    Bodendorfer TW, Briggs GG, Gunning JE. Obtaining drug exposure histories during pregnancy. Am J Obstet Gynecol 1979;135:490–4.PubMedGoogle Scholar
  9. 9.
    Brocklebank JC, Ray WA, Federspiel ChF, Schaffner W. Drug prescribing during pregnancy: a controlled study of Tenessee Medicaid recipients. Am J Obstet Gynecol 1978;132:235–44.PubMedGoogle Scholar
  10. 10.
    Piper JM, Baum C, Kennedy DL. Prescription drug use before and during pregnancy in a Medicaid population. Am J Obstet Gynecol 1987;157:148–57.PubMedGoogle Scholar
  11. 11.
    Collaborative Group on Drug Use in Pregnancy. Drug use in pregnancy: a preliminary report of the International Co-operative Drug Utilization Study. Pharm Weekbl [Sci] 1990;12(2):75–8.Google Scholar
  12. 12.
    Schardein JL. Chemically induced birth defects. New York: Marcel Dekker, 1985:5–11.Google Scholar
  13. 13.
    De Jong-van den Berg LTW, Van den Berg PB, Haaijer-Ruskamp FM, Dukes MNG, Wesseling H. Investigating drug use in pregnancy. Methodological problems and perspectives. Pharm Weekbl [Sci] 1991;13(1):32–8.Google Scholar
  14. 14.
    Nordic Statistics on Medicines 1984–1986. Part II. Nordic Drug Index with Classification and Defined Daily Doses. Uppsala: Nordic Council on Medicines, 1988.Google Scholar
  15. 15.
    Leufkens HG, Hekster YA, Bakker A. Information: selection of data and transformation to time-oriented matrices. In: Muller NF, Hekster YA, eds. Progress in clinical pharmacy. Noordwijk: Amsterdam Medical Press, 1990:45–50.Google Scholar
  16. 16.
    Needs CJ, Brooks PM. Antirheumatic medication in pregnancy. Br J Rheumatol 1985;24:282–90.PubMedGoogle Scholar
  17. 17.
    Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. A reference guide to foetal and neonatal risk. Baltimore: Williams & Wilkins, 1986: 424–8.Google Scholar
  18. 18.
    Wallenburg HCS, Makovitz JW, Dekker GA, Rotman O. Low-dose aspirin prevents pregnancy-induced hypertension and preeclampsia in angiotension sensitive primigravidae. Lancet 1986;1:1–3.CrossRefPubMedGoogle Scholar
  19. 19.
    Beaufils M, Donsimoni R, Uzam S, Colan JC. Prevention of preeclampsia by early antiplatelet therapy. Lancet 1985;1:840–2.CrossRefPubMedGoogle Scholar
  20. 20.
    Sibai BM, Mirro M, Chesney CM, Leffler C. Low-dose aspirin in pregnancy. Obstet Gynecol 1989;74:551–7.PubMedGoogle Scholar

Copyright information

© Royal Dutch Association for Advancement of Pharmacy 1992

Authors and Affiliations

  • L. T. W. De Jong-Van den Berg
    • 1
  • P. B. Van den Berg
    • 1
  • F. M. Haaijer-Ruskamp
    • 2
  • M. N. G. Dukes
    • 2
  • H. Wesseling
    • 3
  1. 1.Department of Pharmacology and Pharmacotherapeutics, Section Pharmacy and SocietyUniversity of GroningenAW Groningenthe Netherlands
  2. 2.Department of Health SciencesUniversity of Groningenthe Netherlands
  3. 3.Department of Pharmacology and Clinical PharmacologyUniversity of Groningenthe Netherlands

Personalised recommendations