Drug prescription in pregnancy: analysis of a large statutory sickness fund population.
OBJECTIVE
To examine the prescription of drugs in Germany prior to, during and after pregnancy.


METHODS
For the first time, prescription data of a large cohort of pregnant women, from a German statutory sickness fund, were available for scientific analysis. For each woman who gave birth between June 2000 and May 2001 reimbursed prescriptions for two periods (90 days each) before pregnancy, three during and two after delivery were considered. The drugs were classified according to the ATC code.


RESULTS
Of the 41,293 women, 96.4% received at least one drug during pregnancy. A median of 7 drugs per women was prescribed. Excluding vitamins, minerals, iodide and iron, 85.2% received at least one drug and the median was 3. Magnesium, which was seldom prescribed outside of pregnancy, was by far the most frequently prescribed substance (20% of all prescriptions, 61% of the women). Iron (54% of the women) and iodide (31%) were also prescribed often. The prescription rates of gynaecological antiinfectives (maximum in third trimester: 23% of the women), antacids (max. in third trim.: 11%), as well as antiemetics and antinauseants (max. in first trim.: 8%) during pregnancy considerably increased. A decrease was seen for analgesics, antiinflammatory and antirheumatic drugs, muscle relaxants, ophtalmologicals and anti-acne preparations, for example. Potential teratogenic drugs were prescribed to 1.3% of the women.


CONCLUSIONS
This analysis of a large nation-wide cohort of pregnant women showed that during pregnancy drugs were prescribed to most women, even when vitamins, minerals, iodide and iron were omitted. Magnesium and iron seemed to have been over-prescribed. On the other hand, the official recommendation for iodide substitution, to prevent thyroid diseases in mother and child, was insufficiently implemented. In our opinion, regular analysis of prescription data can identify potential harmful therapies and focal points where guidelines are needed and can check their implementation.
Institute for Medical Informatics, Biometry and Epidemiology (IBE), University of Munich, Marchioninistrasse 15, 81377, Munich, Germany. egen@ibe.med.uni-muenchen.de
Veronika
V
Egen-Lappe
Joerg
J
Hasford
D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005858:Germany; D006801:Humans; D004366:Nonprescription Drugs / Q000009:adverse effects / Q000627:therapeutic use; D004364:Pharmaceutical Preparations / Q000145:classification; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy
D004366:Nonprescription Drugs; D004364:Pharmaceutical Preparations