Use of Prescribed Drugs to Treat Chronic Diseases during Pregnancy in Outpatient Care in Switzerland between 2014 and 2018: Descriptive Analysis of Swiss Health Care Claims Data

Abstract

Evidence on the use of drugs during pregnancy in Switzerland is lacking. We aimed to evaluate the utilisation of drugs to treat chronic diseases during pregnancy in Switzerland. We identified all pregnancies (excluding abortions) in Swiss Helsana claims data (2014–2018). In those, we identified all claims for drugs to treat a chronic disease, which typically affects women of childbearing age. Potentially teratogenic/fetotoxic drugs were evaluated during specific risk periods. Results were demographically weighted relative to the Swiss population. We identified claims for ≥1 drug of interest during 22% of 369,371 weighted pregnancies. Levothyroxine was most frequently claimed (6.6%). Antihypertensives were claimed during 5.3% (3.9% nifedipine in T3). Renin–Angiotensin–Aldosterone System (RAAS) inhibitors were dispensed to 0.3/10,000 pregnancies during trimester 2 (T2) or trimester 3 (T3). Insulin was claimed during 3.5% of pregnancies, most frequently in T3 (3.3%). Exposure to psychotropic drugs was 3.8% (mostly Selective serotonin reuptake inhibitors (SSRIs)) and to drugs for obstructive airway diseases 3.6%. Traditional immunosuppressants (excluding corticosteroids) were claimed during 0.5% (mainly azathioprine and hydroxychloroquine), biologic immunosuppressants (Tumour necrosis factor-alpha (TNF-alpha) inhibitors and interleukin inhibitors) during 0.2%, and drugs to treat multiple sclerosis during 0.09% of pregnancies. Antiretrovirals were claimed during 0.15% of pregnancies. Patterns of drug claims were in line with treatment recommendations, but relatively rare events of in utero exposure to teratogenic drugs may have had severe implications for those involved.

Use of medications to treat inflammatory bowel diseases before and during pregnancy in Switzerland between 2012 and 2019: an observational study using the claims-based MAMA cohort.

“…Delivery codes registered within a 30-day window of each other were regarded as related to the same pregnancy [23]. The date of delivery was de ned as the rst recorded code during this period, except when both DRG and TARMED codes were available.…”

“…Neither gestational age nor the date of the beginning of pregnancy are recorded in Swiss health insurance data. Thus, the beginning of pregnancy was estimated using an algorithm validated in US claims data [24] and already implemented in a Swiss pregnancy cohort using another claims database [23,25,26].…”

Pharmacotherapy during Pregnancy, Childbirth, and Lactation

“… Overview on the different themes and specific papers discussed in this Special Issue [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. …”

“…In a cross-sectional study of 380 women using combined oral contraceptives, category 3–4 contraindications were present in 31.3% and included—among others—controlled hypertension, major surgery with immobilization, migraine with aura, breastfeeding, or diabetes mellitus with complications [ 16 ]. The use of prescribed medicines to treat chronic diseases during pregnancy has been assessed, using the Swiss Health Care claims data for reimbursement [ 17 ]. Overall, patterns of claims for medicines to treat chronic diseases during pregnancy in Switzerland were in line with treatment recommendations, but rare events of in utero exposure to teratogenic medicines (like renin-angiotensin-aldosterone system inhibitors, or some immune-suppressants).…”

“…Overall, patterns of claims for medicines to treat chronic diseases during pregnancy in Switzerland were in line with treatment recommendations, but rare events of in utero exposure to teratogenic medicines (like renin-angiotensin-aldosterone system inhibitors, or some immune-suppressants). Levothyroxine (6.6%) was the most frequently claimed medicine, antihypertensives (5.3%) were second (nifedipine 3.9%), insulin (3.3%), psychotropics (3.8%) or medicines for obstructive airway diseases (3.6%) were also common [ 17 ].…”