Use of drugs to treat symptoms and acute conditions during pregnancy in outpatient care in Switzerland between 2014 and 2018: analysis of Swiss healthcare claims data

Abstract

BACKGROUND: Evidence on the use of drugs during pregnancy in Switzerland is lacking. OBJECTIVES: To evaluate utilisation of prescribed drugs during pregnancy in outpatient care in Switzerland, focusing on treatments for pain, infections, gastro-oesophageal reflux, nausea/vomiting, and constipation. METHODS: We conducted a descriptive study using the Swiss Helsana claims database (2014–2018). We established a cohort of pregnancies by identifying deliveries and estimating the date of the last menstrual period. We identified claims for the following drugs during pregnancy; analgesics (opioids, paracetamol, and nonsteroidal anti-inflammatory drugs [NSAIDs]), oral antibiotics, antacids, proton pump inhibitors (PPIs), anti-nausea drugs (propulsives and 5HT3-antagonists), and laxatives. Within these drug groups we quantified exposure prevalence to the most prescribed drugs (to >1% of pregnancies) during pregnancy as well as to specific potentially teratogenic or fetotoxic drugs during specific risk periods. Results were extrapolated relative to the demographic distribution of the Swiss population. RESULTS: We identified an extrapolated population of 369,371 pregnancies, with a weighted mean maternal age of 32.0 years (weighted standard deviation 5.1). Analgesics were claimed in 34.5% (95% confidence interval [CI] 33.9–35.0%) of pregnancies, most frequently paracetamol (30.3%, 29.8–30.8%), followed by NSAIDs (8.6%, 8.3–8.8%), and opioids (2.6%, 2.4–2.8%). NSAIDs were claimed in 1.3% (1.2–1.4%) of pregnancies after week 24, and opioids were claimed in 1.3% (1.2–1.4%) in trimester 3. Antibiotics were dispensed in 26.3% (25.8–26.8%) of pregnancies, most frequently amoxicillin (14.6%, 95% CI 14.2–14.9%). Claims for potentially teratogenic or fetotoxic antibiotics during risk periods were each recorded in <0.6% of pregnancies. PPIs were claimed in 16.0% (15.6–16.3%) and antacids in 10.6% (10.3–11.0%) of pregnancies, but several antacid products are not reimbursed and thus not present in insurance claims. Anti-nausea drugs were claimed in 16.4% (16.0–16.7%) of pregnancies, most frequently metoclopramide in 14.4% (14.0–14.7%). Ondansetron was mainly dispensed in trimester 1, 1.0% (0.9–1.1%). In total, 6.4% (6.2–6.7%) of pregnancies had a claim for laxatives, most frequently for macrogol (2.4%, 95% CI 2.2–2.5%). CONCLUSION: The observed pattern of claimed drugs during pregnancy is in line with existing treatment guidelines. Exposure to potentially teratogenic and fetotoxic drugs was small, but given the lack of recorded diagnosis, we cannot determine if their use was clinically indicated.

Self-Reported Medication Use among Pregnant and Postpartum Women during the Third Wave of the COVID-19 Pandemic: A European Multinational Cross-Sectional Study

“…The most changed "chronic" medications reported by women were analgesics and antihistamines. The identification of these classes is, however, not surprising given that both classes are typically the most used ones during pregnancy and postpartum [32,33], which was also the case in our study population. Although asthma medications were not among the ten most used classes in our study, they were the fourth most changed class due to COVID-19.…”

“…However, similarly to the first wave (3%), the self-reported use of systemic antibiotics was less prevalent among pregnant women (2%) than in prepandemic reports. Indeed, 14% of Lupatelli et al's pregnant participants reported having used a systemic antibiotic [32], and at least 26% of women were prescribed an antibiotic at some point in pregnancy, according to a recently published Swiss claims database cohort [33]. Although our prevalence of systemic antibiotic use may be underestimated due to questioning only the three preceding months, the use/dispensing of systemic antibiotics was equally frequent in each pregnancy trimester in both studies [32,33].…”

“…Although our prevalence of systemic antibiotic use may be underestimated due to questioning only the three preceding months, the use/dispensing of systemic antibiotics was equally frequent in each pregnancy trimester in both studies [32,33]. Thus, a three-month study period should provide a good reflection of antibiotic use during pregnancy [32,33]. Similar decreases in antibiotics use have also been observed in the general population during the pandemic [34], suggesting a reduced incidence of other infectious diseases due to preventive sanitary measures against COVID-19.…”

“…Indeed, 14% of Lupatelli et al's pregnant participants reported having used a systemic antibiotic [32], and at least 26% of women were prescribed an antibiotic at some point in pregnancy, according to a recently published Swiss claims database cohort [33]. Although our prevalence of systemic antibiotic use may be underestimated due to questioning only the three preceding months, the use/dispensing of systemic antibiotics was equally frequent in each pregnancy trimester in both studies [32,33]. Thus, a three-month study period should provide a good reflection of antibiotic use during pregnancy [32,33].…”

Information Needs and Counseling Preferences among Potential Users of the Future Teratology Information Service in Belgium: A Cross-Sectional Study Involving the Public and Healthcare Professionals

“…Specific groups of medicines for which HCPs want information were identified, including systemic anti-infectives and respiratory and alimentary tract medicines. These medicines are also regularly used in this population [ 30 , 31 , 32 , 33 , 34 , 35 ]. Moreover, women and HCPs expressed their interest in having access to information on herbal remedies.…”