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European Journal of Clinical Pharmacology

, Volume 60, Issue 9, pp 659–666 | Cite as

Drug prescription in pregnancy: analysis of a large statutory sickness fund population

  • Veronika Egen-Lappe
  • Joerg Hasford
Pharmacoepidemiology and Prescription

Abstract

Objective

To examine the prescription of drugs in Germany prior to, during and after pregnancy.

Methods

For the first time, prescription data of a large cohort of pregnant women, from a German statutory sickness fund, were available for scientific analysis. For each woman who gave birth between June 2000 and May 2001 reimbursed prescriptions for two periods (90 days each) before pregnancy, three during and two after delivery were considered. The drugs were classified according to the ATC code.

Results

Of the 41,293 women, 96.4% received at least one drug during pregnancy. A median of 7 drugs per women was prescribed. Excluding vitamins, minerals, iodide and iron, 85.2% received at least one drug and the median was 3. Magnesium, which was seldom prescribed outside of pregnancy, was by far the most frequently prescribed substance (20% of all prescriptions, 61% of the women). Iron (54% of the women) and iodide (31%) were also prescribed often. The prescription rates of gynaecological antiinfectives (maximum in third trimester: 23% of the women), antacids (max. in third trim.: 11%), as well as antiemetics and antinauseants (max. in first trim.: 8%) during pregnancy considerably increased. A decrease was seen for analgesics, antiinflammatory and antirheumatic drugs, muscle relaxants, ophtalmologicals and anti-acne preparations, for example. Potential teratogenic drugs were prescribed to 1.3% of the women.

Conclusion

This analysis of a large nation-wide cohort of pregnant women showed that during pregnancy drugs were prescribed to most women, even when vitamins, minerals, iodide and iron were omitted. Magnesium and iron seemed to have been over-prescribed. On the other hand, the official recommendation for iodide substitution, to prevent thyroid diseases in mother and child, was insufficiently implemented. In our opinion, regular analysis of prescription data can identify potential harmful therapies and focal points where guidelines are needed and can check their implementation.

Keywords

Iodine Deficiency Anatomical Therapeutic Chemical Prescription Rate Prescription Data Sickness Fund 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

The study was funded by the Deutsche Forschungsgemeinschaft (DFG) (German Research Foundation), a central, self-governing, research organisation that promotes research at universities and other publicly financed research institutions in Germany (project identification no. 226661). We thank the Techniker Krankenkasse for providing the data and Dr. Günther, Dr. Köthemann and all other persons involved in the project for their very engaged support. We thank J. Kerr, Ph.D., for linguistical revision of the paper.

References

  1. 1.
    Bonati M, Bortolus R, Marchetti F, Romero M, Tognoni G (1990) Drug use in pregnancy: an overview of epidemiological (drug utilization) studies. Eur J Clin Pharmacol 38:325–328PubMedGoogle Scholar
  2. 2.
    Collaborative group on drug use in pregnancy (CGDUP) (1992) Medication during pregnancy: an intercontinental cooperative study. Int J Gynecol Obstet 39:185–196Google Scholar
  3. 3.
    De Vigan C, De Walle HEK, Cordier S, Goujard J, Knill-Jones R, Aymé S, Calzolari E, Bianchi F, OECM Working Group (1999) Therapeutic drug use during pregnancy: a comparison in four European countries. J Clin Epidemiol 52:977–982CrossRefPubMedGoogle Scholar
  4. 4.
    Hoffmann A, Jäger O, Peiker G, Reimann I (1992) Drug use in pregnancy: East German data of an international collaborative study. Int J Clin Pharmacol Ther Toxicol 30:462–464PubMedGoogle Scholar
  5. 5.
    Reimann I, Karpinsky C, Hoffmann A (1996) Epidemiological data on drug use during pregnancy in Thuringia, East Germany, 1993. Int J Clin Pharmacol Ther 34:80–83PubMedGoogle Scholar
  6. 6.
    Irl C, Hasford J, and the PEGASUS-Study Group (1997) The PEGASUS-project—a prospective cohort study for the investigation of drug use in pregnancy. Int J Clin Pharmacol Ther 35:572–576PubMedGoogle Scholar
  7. 7.
    Egen V, Roesch C, Steinbicker V, Hasford J (2002) Drug utilization during pregnancy – a comparison between East and West Germany. Pharmacoepidemiol Drug Saf 11:S148–S149Google Scholar
  8. 8.
    De Jong-van den Berg LTW, Waardenburg CM, Haaijer-Ruskamp FM, Dukes MNG, Wesseling H (1993) Drug use in pregnancy: a comparative appraisal of data collecting methods. Eur J Clin Pharmacol 45:9–14PubMedGoogle Scholar
  9. 9.
    Briggs GG, Freeman RK, Yaffe SJ (2002) Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. Williams and Wilkins, BaltimoreGoogle Scholar
  10. 10.
    Koren G, Pastuszak A, Ito S (1998) Drugs in pregnancy. NEJM 338:1128–1137CrossRefPubMedGoogle Scholar
  11. 11.
    Schwabe U, Ziegler R (2001) Mineralstoffpräparate und Osteoporosemittel. In: Schwabe U, Paffrath D (eds) Arzneiverordnungsreport 2000. Springer, Berlin Heidelberg New York, p 502Google Scholar
  12. 12.
    World Health Organization (WHO) (1992) Maternal health and safe motherhood programme—nutrition programme. The prevalence of anaemia in women: a tabulation of available information. World Health Organization, GenevaGoogle Scholar
  13. 13.
    Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (1993) Ernährung und Stoffwechselfragen in der Schwangerschaft. I. Jodversorgung für Schwangere. Frauenarzt 34:10–12Google Scholar
  14. 14.
    Grospietsch G (2000) Erkrankungen in der Schwangerschaft: ein Leitfaden mit Therapieempfehlungen für Klinik und Praxis. Wiss. Verl.-Ges., Stuttgart, p 298Google Scholar
  15. 15.
    Anonymous (1999) Sonstige Hilfen-Richtlinien. Änderung der Sonstige Hilfen-Richtlinien. Dt Ärzteblatt 96:A-231–A-232Google Scholar
  16. 16.
    Köster I, von Ferber L, Schubert I (1996) Häufigkeit und Umfang der ärztlichen Inanspruchnahme während der Schwangerschaft. Frauenarzt 37:1242–1250Google Scholar
  17. 17.
    Olesen C, Hald Steffensen F, Lauge Nielsen G, de Jong-van den Berg L, Olsen J, Toft Sorensen H, and The Euromap Group (1999) Drug use in first pregnancy and lactation: a population-based survey among Danish women. Eur J Clin Pharmacol 55:139–144CrossRefPubMedGoogle Scholar
  18. 18.
    Malm H, Martikainen J, Klaukka T, Neuvonen J (2003) Prescription drugs during pregnancy and lactation—a Finnish register-based study. Eur J Clin Pharmacol 59:127–133PubMedGoogle Scholar
  19. 19.
    De Jong-van den Berg LTW, van den Berg PB, Haaijer-Ruskamp FM, Dukes MNG, Wesseling H (1991) Investigating drug use in pregnancy. Methodological problems and perspectives. Pharm Weekbl [Sci] 13:32–38Google Scholar
  20. 20.
    Lacroix I, Damase-Michel C, Lapeyre-Mestre M, Montastruc JL (2000) Prescription of drugs during pregnancy in France. Lancet 356:1735–1736CrossRefPubMedGoogle Scholar
  21. 21.
    Beyens MN, Guy C, Ratrema M, Ollagnier M (2003) Prescription of drugs to pregnant women in France: the HIMAGE study. Therapie 58:505–511PubMedGoogle Scholar
  22. 22.
    Statistisches Bundesamt (2002) Statistisches Jahrbuch. Statistisches Bundesamt, p 62Google Scholar
  23. 23.
    Statistisches Bundesamt (2003) Durchschnittliches Alter der Mütter bei der Geburt ihrer lebendgeborenen Kinder. http://www.destatis.de/basis/d/bevoe/bevoetab2.htm

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Institute for Medical Informatics, Biometry and Epidemiology (IBE)University of MunichMunichGermany

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