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Prescription drugs during pregnancy and lactation—a Finnish register-based study

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Objective

To examine the use of prescription drugs in Finnish women before and during pregnancy and lactation.

Methods

A register-based study linking four nation-wide registers in Finland: the Maternal Grants Register, the Drug Prescription Register, and the Special Refund Register (all maintained by the Social Insurance Institution in Finland; KELA), and the Finnish Population Register. The study included all women applying for maternity support (maternal grants) during the year 1999, and non-pregnant control women matched by age and hospital district. Data collection included the number and type of prescription drugs purchased by the two cohorts during preconception (3 months before pregnancy), each trimester, and lactation.

Results

Of the 43,470 pregnant women, 46.2% purchased at least one drug and 12.7% three or more different drugs during pregnancy. Corresponding proportions for the control cohort were 55.2% (OR 0.7, 95% CI 0.6–0.7) and 23.0% (OR 0.5, 95% CI 0.5–0.5). The drugs most frequently purchased during pregnancy were systemic antibiotics (24.1% of pregnant women vs 27.3% controls; OR 0.8, 95% CI 0.8–0.9) and gynaecological anti-infective agents (8.3% vs 1.5%; OR 5.5, 95% CI 5.5–6.5). For pregnant women, purchases of most drug groups had already declined during the first trimester, but no reduction was apparent in drugs for chronic illnesses (epilepsy, asthma, diabetes).

Conclusions

Although drugs were purchased abundantly during pregnancy, a significant decline occurred for most drug groups. The medication pattern for chronic illnesses remained unchanged. The purchase of several different drugs was relatively common and raises concerns.

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References

  1. Norman RJ (2001) Reproductive consequences of COX-2 inhibition. Lancet 358:1287–1288

    Article  CAS  PubMed  Google Scholar 

  2. Pall M, Friden BE, Brännström M (2001) Induction of delayed follicular rupture in the human by the selective COX-2 inhibitor rofecoxib: a randomized double-blind study. Hum Reprod 16:1323–1328

    Article  CAS  PubMed  Google Scholar 

  3. Balasubramaniam J (2000) Nimesulide and neonatal failure. Lancet 355:575

    CAS  Google Scholar 

  4. Saji H, Yamanca M, Hagieara A, Ijiri R (2001) Losartan and fetal toxic effects. Lancet 357:363

    Article  CAS  Google Scholar 

  5. Mantovani A, Calamandrei G (2001) Delayed developmental effects following prenatal exposure to drugs. Review. Curr Pharm Des 7:859–880

    CAS  PubMed  Google Scholar 

  6. 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 38:325–328

    Google Scholar 

  7. Collaborative group on drug use in pregnancy (1992) Medication during pregnancy: an intercontinental cooperative study. Int J Gynecol Obstet 39:185–196

    Google Scholar 

  8. Donati S, Baglia G, Spinelli A, Grandolgo ME (2000) Drug use in pregnancy among Italian women. Eur J Clin Pharmacol 56:323–329

    Article  Google Scholar 

  9. De Vigan C, De Walle HC, Cordier S, Coujard J, Knill-Jones R, Ayme S et al (1999) Therapeutic drug use during pregnancy: a comparison in four European countries. J Clin Epidemiol 52:977–982

    Google Scholar 

  10. Irl C, Hasford J (1997) The PEGASUS project—a prospective cohort study for the investigation of drug use in pregnancy. Int J Clin Pharmacol 35:572–576

    CAS  Google Scholar 

  11. Olesen C, Hald Steffensen F, Nielsen GL, de Jong-van den Berg L, Olsen J, Toft Sorensen H et al (1999) Drug use in first pregnancy and lactation: a population-based survey among Danish women. Eur J Clin Pharmacol 55:139–144

    Google Scholar 

  12. Lacroix I, Damase-Michel C, Lapeyre-Mestre M, Montastruck JL (2000) Prescription of drugs during pregnancy in France. Lancet 356:735–736

    Article  CAS  PubMed  Google Scholar 

  13. Finnish Statistics on Medicines 2000 (2001) National Agency for Medicines and Social Insurance Institution. Edita, Helsinki

  14. Ruigomez A, Garcia Rodriguez LA, Cattaruzzi C, Troncon MG, Agostinis L, Wallander MA et al (1999) Use of cimetidine, omeprazole, and ranitidine in pregnant women and pregnancy outcomes. Am J Epidemiol 150:476–481

    CAS  PubMed  Google Scholar 

  15. Broussard CN, Richter JE (1998) Treating gastro-oesophageal reflux disease during pregnancy and lactation: what are the safest therapy options? Drug Saf 19:325–337

    CAS  PubMed  Google Scholar 

  16. Ericson A, Källen B (2001) Nonsteroidal anti-inflammatory drugs in early pregnancy. Reproductive Toxicol 15:371–375

    CAS  Google Scholar 

  17. Olesen C, Sondergaard C, Thrane N, Lauge Nielsen G, de Jong-van den Berg L, Olsen J (2001) Do pregnant women report use of dispensed medications? Epidemiology 12:497–501

    CAS  PubMed  Google Scholar 

  18. Buitendijk S, Bracken M (1991) Medication in early pregnancy: prevalence of use and relationship to maternal characteristics. Am J Obstet Gyncol 165:33–40

    CAS  Google Scholar 

  19. Larivaara P, Hartikainen A-L, Rantakallio P (1996) Use of psychotropic drugs and pregnancy outcome. J Clin Epidemiol 11:1309–1313

    Article  Google Scholar 

  20. Nordeng H, Eskild A, Nesheim B, Aursnes I, Jacobsen G (2001) Drug use during early pregnancy. The impact of maternal illness, outcome of prior pregnancies and socio-demographic factors. Eur J Clin Pharmacol 57:259–263

    CAS  PubMed  Google Scholar 

  21. Ericson A, Kallen B, Wiholm B (1999) Delivery outcome after the use of antidepressants in early pregnancy. Eur J Clin Pharmacol 55:503–508

    CAS  PubMed  Google Scholar 

  22. Kekki M, Kurki T, Pelkonen J, Kurkinen-Raty M, Cacciatore B, Paavonen J (2001) Vaginal clindamycin in preventing preterm birth and peripartal infections in asymptomatic women with bacterial vaginosis. A randomized, controlled trial. Obstet Gynecol 97:643–648

    CAS  PubMed  Google Scholar 

  23. Vermeulen GM, Zwet van AA, Bruinse HW (2001) Changes in the vaginal flora after two percent clindamycin vaginal cream in women at high risk of spontaneous preterm birth. Br J Obstet Gynecol 108:697–700

    Article  CAS  Google Scholar 

  24. Hernandez-Diaz S, Werler MM, Walker AA, Mitchell A (2000) Folic acid antagonists during pregnancy and the risk of birth defects. N Engl J Med 343:1608–1614

    PubMed  Google Scholar 

  25. Jadad AR, Sigouin C, Mohide PT, Levine M, Fuentes M (2000) Risk of congenital malformations associated with treatment of asthma during early pregnancy. Lancet 355:119

    Article  CAS  PubMed  Google Scholar 

  26. Yerby MS (2000) Quality of life, epilepsy advances, and the evolving role of anticonvulsants in women with epilepsy. Neurology 55:21–31

    Google Scholar 

  27. Cohen LS, Friedman JM, Jefferson JW, Johnson EM, Weiner ML (1994) A reevaluation of risk of in utero exposure to lithium. JAMA 271:146–150

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors want to thank Ms. Hilkka Ruuska at The Social Insurance Institution, Helsinki, for her skilled technical assistance, and researcher Anneli Miettinen at The Family Federation of Finland for consultation help in statistical issues.

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Authors and Affiliations

  1. Teratology Information Service, Department of Medical Genetics, The Family Federation of Finland, Helsinki, Finland

    Heli Malm

  2. The Social Insurance Institution, Helsinki, Finland

    Jaana Martikainen & Timo Klaukka

  3. Department of Clinical Pharmacology, Helsinki University Central Hospital, P.O. Box 340, 00029 HUS, Finland

    Heli Malm & Pertti J. Neuvonen

Authors
  1. Heli Malm
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  2. Jaana Martikainen
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  3. Timo Klaukka
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  4. Pertti J. Neuvonen
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Correspondence to Heli Malm.

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Malm, H., Martikainen, J., Klaukka, T. et al. Prescription drugs during pregnancy and lactation—a Finnish register-based study. Eur J Clin Pharmacol 59, 127–133 (2003). https://doi.org/10.1007/s00228-003-0584-4

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  • DOI: https://doi.org/10.1007/s00228-003-0584-4

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