What changes in prescription patterns of antiemetic medications in pregnant women in France?

Abstract

Background:In France, few data are available on the prescription patterns of antiemetic medications in pregnant women. Objectives:The purpose of this study was to describe antiemetic medication prescriptions and trends over time. Can we observe significant changes in pregnant woman prescriptions in recent years? Methods:We conducted a drug utilization study among pregnant women using data from the EFEMERIS database, including 135 574 pregnant women who had a pregnancy outcome between 2004 and 2017 in Haute-Garonne (France).Results: During the study period, 40 028 women (29.5%) received at least one antiemetic prescription during pregnancy. Metoclopramide (56.6%), domperidone (34.9%), and metopimazine (28.5%) were the most commonly prescribed antiemetics, whatever the trimester of pregnancy. Prescriptions of ondansetron only concerned 53 women (0.1%). The prevalence of women who received at least one prescription for an antiemetic decreased from 32.5% in 2010 to 21.6% in 2017. This decline mainly concerned domperidone prescriptions (from 13.1% in 2010 to 1.2% in 2017). Metoclopramide prescriptions also decreased slightly (18.3% in 2010 and 14.0% in 2017). Metopimazine prescriptions increased lowly (8.0% in 2010 and 9.0% in 2017). Conclusion:This study showed a decrease of antiemetic prescriptions between 2010 and 2017, linked to the sharp decrease in domperidone use from 2011, probably related to warnings about the risk of cardiovascular adverse effects following exposure to domperidone. We could not observe real switches to other antiemetic medications. No switches to ondansetron could be noted either, with only rare exposure during pregnancy, contrary to other countries, like the United States.

Guidelines for Treatment of Hyperemesis Gravidarum and Implementation in Clinical Practice in Norway: A Descriptive Study

“…Te serotonin antagonist ondansetron ofers an alternative mechanism of action to dopamine antagonists and antihistamines which might provide additive antiemetic efects and is third-line treatment according to guidelines, advised to be reserved for severe cases [9][10][11]. In 2014, ondansetron was used by 22% of all pregnant women in a study from the USA [22], while only by 0.04% of pregnant women (2004-2017) in a French region [23]. Comparably, prescription flls for ondansetron were found in 1.0% of pregnancies in the Norwegian prescription database in 2017 [24].…”

Risk of abnormal pregnancy outcomes after using ondansetron during pregnancy: A systematic review and meta-analysis

“…In Norway, 0.3% of pregnant women take ondansetron prescriptions, of which 76.9% are initially used in the first 3 months of pregnancy (van Gelder and Nordeng, 2021). In France, ondansetron prescriptions involved only 53 women (0.1%) between 2004 and 2017 in Haute-Garonne, contrary to other countries, like the US (Hurault-Delarue et al, 2021),…”