Health care providers’ requests to Teratogen Information Services on medication use during pregnancy and lactation
- 263 Downloads
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.
KeywordsCross-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.
- 16.Medications pal. (2005–2006) Pharmaceutical chair Louis-Boivin family. Annual reportGoogle Scholar
- 17.Health Canada (2008) Health Canada Drug Product Database (DPD). Available at: http://www.hc-sc.gc.ca/dhp-mps/prodpharma/databasdon/index-eng.php
- 18.World Health Organization (WHO) (2008). Anatomical Therapeutic Chemical (ATC) classification. Available at: http://www.whocc.no/atcddd/atcsystem.html
- 19.MSSO (2008) MedDRA terminology. Available at: http://www.meddramsso.com
- 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: http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2004/2004_44-eng.php
- 21.Health Canada (2006) Newer antidepressants linked to serious lung disorder in newborns. http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2006/2006_11-eng.php
- 22.Health Canada (2004) CELEBREX (celecoxib) capsules important safety information. Available at: http://www.hc-sc.gc.ca/dhp-mps/medeff/advisories-avis/prof/_2004/celebrex_2_hpc-cps-eng.php
- 23.Health Canada (2004). Merck Sharp & Dohme (MSD) announces voluntary worldwide withdrawal of VIOXX (rofecoxib). Available at:http://www.hc-sc.gc.ca/dhp-mps/medeff/advisories-avis/prof/_2004/vioxx_2_ltp-lp-eng.php
- 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: http://www.fda.gov/cder/drug/advisory/COX2.htm
- 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
- 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
- 34.Quebec government (2008). The fight against smoking. Available at: http://msss.gouv.qc.ca/sujets/santepub/tabac/index.php?aid=98
- 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
- 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.Statistics Canada, Canada’s national statistical agency (2007). Births 2005. Available at: http://www.statcan.ca/bsolc/english/bsolc?catno=84F0210X 84F0210XWE