European Journal of Clinical Pharmacology

, Volume 65, Issue 5, pp 523–531 | Cite as

Health care providers’ requests to Teratogen Information Services on medication use during pregnancy and lactation

  • Marie-Pierre Gendron
  • Brigitte Martin
  • Driss Oraichi
  • Anick Bérard
Pharmacoepidemiology and Prescription



Medication use during pregnancy and lactation is prevalent. However, current knowledge of the risks and benefits of medication use during pregnancy and lactation is incomplete as the best available evidence has been obtained from cohort studies of inadvertent exposures and registries. This situtation may partly explain health care providers’ (HCP) risk perceptions and thus the increasing number of calls to Teratogen Information Services (TIS).


The objectives of this study were (1) to identify the medication classes for which HCP are seeking counseling from the IMAGe center, a Quebec TIS; (2) to identify the medical conditions for which medication classes were used during pregnancy and lactation; (3) to identify and quantify predictors of medication information requests during pregnancy and lactation.


A retrospective analysis of data was conducted within the population served by the IMAGe center, a TIS based at CHU Ste-Justine in Montreal, Quebec, Canada, that serves the French population of Canada. To be included, calls had to be received between January 1, 2004 and April 30, 2007, and the subject of the call had to be directly associated with the exposure, or not, of a pregnant or breastfeeding woman to medication. Multivariate generalized estimating equation (GEE) regression models were performed to identify the predictors of medication requests.


A total of 11, 076 requests regarding medication exposure during pregnancy, 12 055 requests regarding pregnant women before the exposure took place, and 13, 364 requests regarding lactation were included for analyses. Pregnant women were most frequently exposed to antidepressants (17.3), antibiotics (6.3%), and benzodiazepines (5.3%). Prior to drug exposure, the most frequent inquiries by HCP were on antibiotics (11.0%), anti-inflammatory drugs (6.0%), and antiemetics (5.1%). Inquiries concerning lactating women most frequently requested information on the drug classes of antidepressants (10.8%), antibiotics (9.1%), and anti-inflammatory drugs (7.8%). Depressive disorders were an indication of antidepressant, benzodiazepine and antipsychotic exposures reported to IMAGe. Associations were found between medication use and maternal age, previous pregnancies, trimester of pregnancy at the time of the call and lifestyle habits.


The IMAGe received frequent inquiries on antidepressant, antibiotic, and benzodiazepine exposures, with depressive disorders being the most frequently declared indication. Predictors of medication requests were identified among exposed women during pregnancy, and breastfeeding women. These results emphasize the need for effective studies on drug use during pregnancy and lactation and for better knowledge transfer programs.


Cross-sectional study IMAGe Lactation Medications Predictors Pregnancy 



The infrastructure used for this study was supported by the Canadian Foundation for Innovation (CFI). Marie-Pierre Gendron is the recipient of a Master’s research bursary from the CHU Sainte-Justine’s Foundation and the Foundation for Research into Children’s Diseases (Foundation of Stars). Dr. Anick Bérard is the recipient of a career award from the Canadian Institutes of Health Research (CIHR)/Health Research Foundation and is on the endowment research Chair of the Famille Louis-Boivin on ‘Medications, Pregnancy, and Lactation’ at the Faculty of Pharmacy of the University of Montreal.

Conflict of Interest

The authors declare that there are no conflicts of interest.


  1. 1.
    Andrade SE, Gurwitz JH, Davis RL, Chan KA, Finkelstein JA, Fortman K et al (2004) Prescription drug use in pregnancy. Am J Obstet Gynecol 191(2):398–407PubMedCrossRefGoogle Scholar
  2. 2.
    De VC, De Walle HE, Cordier S, Goujard J, Knill-Jones R, Ayme S et al (1999) Therapeutic drug use during pregnancy: a comparison in four European countries. OECM Working Group. Occupational Exposures and Congenital Anomalies. J Clin Epidemiol 52(10):977–82CrossRefGoogle Scholar
  3. 3.
    Malm H, Martikainen J, Klaukka T, Neuvonen PJ (2003) Prescription drugs during pregnancy and lactation-a Finnish register-based study. Eur J Clin Pharmacol 59(2):127–33PubMedGoogle Scholar
  4. 4.
    Olesen C, Steffensen FH, Nielsen GL, de Jong-van den Berg LT, Olsen J, Sorensen HT (1999) Drug use in first pregnancy and lactation: a population-based survey among Danish women. The EUROMAP group. Eur J Clin Pharmacol 55(2):139–44PubMedCrossRefGoogle Scholar
  5. 5.
    Egen-Lappe V, Hasford J (2004) Drug prescription in pregnancy: analysis of a large statutory sickness fund population. Eur J Clin Pharmacol 60(9):659–66PubMedCrossRefGoogle Scholar
  6. 6.
    Headley J, Northstone K, Simmons H, Golding J (2004) Medication use during pregnancy: data from the Avon Longitudinal Study of Parents and Children. Eur J Clin Pharmacol 60(5):355–361PubMedCrossRefGoogle Scholar
  7. 7.
    Lacroix I, Damase-Michel C, Lapeyre-Mestre M, Montastruc JL (2000) Prescription of drugs during pregnancy in France. Lancet 356(9243):1735–1736PubMedCrossRefGoogle Scholar
  8. 8.
    Refuerzo JS, Blackwell SC, Sokol RJ, Lajeunesse L, Firchau K, Kruger M et al (2005) Use of over-the-counter medications and herbal remedies in pregnancy. Am J Perinatol 22(6):321–324PubMedCrossRefGoogle Scholar
  9. 9.
    Beyens MN, Guy C, Ratrema M, Ollagnier M (2003) Prescription of drugs to pregnant women in France: the HIMAGE study. Therapie 58(6):505–511PubMedCrossRefGoogle Scholar
  10. 10.
    Schirm E, Schwagermann MP, Tobi H, De Jong–Van Den Berg LT (2004) Drug use during breastfeeding. A survey from the Netherlands. Eur J Clin Nutr 58(2):386–390PubMedCrossRefGoogle Scholar
  11. 11.
    Ofori B, Oraichi D, Blais L, Rey E, Berard A (2006) Risk of congenital anomalies in pregnant users of non-steroidal anti-inflammatory drugs: a nested case-control study. Birth Defects Res B Dev Reprod Toxicol 77(4):268–279PubMedCrossRefGoogle Scholar
  12. 12.
    Garriguet D (2006) Medication use among pregnant women. Health Rep 17(2):9–18PubMedGoogle Scholar
  13. 13.
    Matheson I, Kristensen K, Lunde PK (1990) Drug utilization in breast-feeding women. A survey in Oslo. Eur J Clin Pharmacol 38(5):453–459PubMedCrossRefGoogle Scholar
  14. 14.
    Stultz EE, Stokes JL, Shaffer ML, Paul IM, Berlin CM (2007) Extent of medication use in breastfeeding women. Breastfeed Med 2(3):145–151PubMedCrossRefGoogle Scholar
  15. 15.
    Sanz E, Gomez-Lopez T, Martinez-Quintas MJ (2001) Perception of teratogenic risk of common medicines. Eur J Obstet Gynecol Reprod Biol 95(1):127–131PubMedCrossRefGoogle Scholar
  16. 16.
    Medications pal. (2005–2006) Pharmaceutical chair Louis-Boivin family. Annual reportGoogle Scholar
  17. 17.
    Health Canada (2008) Health Canada Drug Product Database (DPD). Available at:
  18. 18.
    World Health Organization (WHO) (2008). Anatomical Therapeutic Chemical (ATC) classification. Available at:
  19. 19.
    MSSO (2008) MedDRA terminology. Available at:
  20. 20.
    Health Canada (2004) New safety information regarding paroxetine: findings suggest increased risk over other antidepressants, of congenital malformations following first trimester exposure to paroxetine. Available at:
  21. 21.
    Health Canada (2006) Newer antidepressants linked to serious lung disorder in newborns.
  22. 22.
    Health Canada (2004) CELEBREX (celecoxib) capsules important safety information. Available at:
  23. 23.
    Health Canada (2004). Merck Sharp & Dohme (MSD) announces voluntary worldwide withdrawal of VIOXX (rofecoxib). Available at:
  24. 24.
    US Food and Drug Administration (2005). FDA announces important changes and additional warnings for COX-2 selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs). Available at:
  25. 25.
    Li DK, Liu L, Odouli R (2003) Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study. Br Med J 327(7411):368CrossRefGoogle Scholar
  26. 26.
    Einarson A, Portnoi G, Koren G (2002) Update on motherisk updates. Seven years of questions and answers. Can Fam Physician 48:1301–1304PubMedGoogle Scholar
  27. 27.
    De SM, Cesari E, Ligato MS, Nobili E, Straface G, Cavaliere A et al (2008) Prenatal drug exposure and teratological risk: One-year experience of an Italian Teratology Information Service. Med Sci Monit 14(2):H1–H8Google Scholar
  28. 28.
    Austin MP, Mitchell PB (1998) Use of psychotropic medications in breast-feeding women: acute and prophylactic treatment. Aust N Z J Psychiatry 32(6):778–84PubMedCrossRefGoogle Scholar
  29. 29.
    Ramos E, Oraichi D, Rey E, Blais L, Berard A (2007) Prevalence and predictors of antidepressant use in a cohort of pregnant women. Br J Obstet Gynaecol 114(9):1055–1064Google Scholar
  30. 30.
    Ho-Yen SD, Bondevik GT, Eberhard-Gran M, Bjorvatn B (2007) Factors associated with depressive symptoms among postnatal women in Nepal. Acta Obstet Gynecol Scand 86(3):291–297PubMedCrossRefGoogle Scholar
  31. 31.
    Zuckerman B, Amaro H, Bauchner H, Cabral H (1989) Depressive symptoms during pregnancy: relationship to poor health behaviors. Am J Obstet Gynecol 160(5 Pt 1):1107–1111PubMedGoogle Scholar
  32. 32.
    Zilberman ML, Tavares H, Blume SB, el-Guebaly N (2003) Substance use disorders: sex differences and psychiatric comorbidities. Can J Psychiatry 48(1):5–13PubMedGoogle Scholar
  33. 33.
    Amann U, Egen-Lappe V, Strunz-Lehner C, Hasford J (2006) Antibiotics in pregnancy: analysis of potential risks and determinants in a large German statutory sickness fund population. Pharmacoepidemiol Drug Saf 15(5):327–337PubMedCrossRefGoogle Scholar
  34. 34.
    Quebec government (2008). The fight against smoking. Available at:
  35. 35.
    Bullen C (2008) Impact of tobacco smoking and smoking cessation on cardiovascular risk and disease. Expert Rev Cardiovasc Ther 6(6):883–895PubMedCrossRefGoogle Scholar
  36. 36.
    Nightingale AL, Lawrenson RA, Simpson EL, Williams TJ, MacRae KD, Farmer RD (2000) The effects of age, body mass index, smoking and general health on the risk of venous thromboembolism in users of combined oral contraceptives. Eur J Contracept Reprod Health Care 5(4):265–274PubMedCrossRefGoogle Scholar
  37. 37.
    Roy S (1999) Effects of smoking on prostacyclin formation and platelet aggregation in users of oral contraceptives. Am J Obstet Gynecol 180(6 Pt 2):S364–S368PubMedCrossRefGoogle Scholar
  38. 38.
    Karsak M, Gaffal E, Date R, Wang-Eckhardt L, Rehnelt J, Petrosino S et al (2007) Attenuation of allergic contact dermatitis through the endocannabinoid system. Science 316(5830):1494–1497PubMedCrossRefGoogle Scholar
  39. 39.
    Demyttenaere K, Bonnewyn A, Bruffaerts R, De GG, Gasquet I, Kovess V et al (2008) Clinical factors influencing the prescription of antidepressants and benzodiazepines: results from the European study of the epidemiology of mental disorders (ESEMeD). J Affect Disord 110(1–2):84–93PubMedCrossRefGoogle Scholar
  40. 40.
    Statistics Canada, Canada’s national statistical agency (2007). Births 2005. Available at: 84F0210XWE

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Marie-Pierre Gendron
    • 1
    • 2
  • Brigitte Martin
    • 3
  • Driss Oraichi
    • 2
  • Anick Bérard
    • 1
    • 2
  1. 1.Faculty of PharmacyUniversity of MontrealMontrealCanada
  2. 2.Research CenterCHU Sainte-JustineMontrealCanada
  3. 3.Department of PharmacyCHU Sainte-JustineMontrealCanada

Personalised recommendations