title: Use of antirheumatic drugs in mothers and fathers before and during pregnancy-a population-based cohort study.
abstract: OBJECTIVE
  Exploring the use of antirheumatic drugs in pregnant women and expectant fathers.
  
  
  METHODS
  Population-based cohort study, based on linkage of two nationwide databases: the Norwegian Prescription Database was linked to data on 106 000 pregnancies during 2004-2006 from the Medical Birth Registry of Norway. Antirheumatic drugs dispensed to mothers 3 months prior to conception, during pregnancy, and up to 6 months after delivery, and prescriptions to fathers 3 months prior to conception were identified.
  
  
  RESULTS
  During the 18-month observation period for each pregnancy, 1411 women (1.3% of the women) redeemed at least one antirheumatic drug. Of these, 45% received at least one drug during 3 months prior to conception and 28% in the first trimester. Four women redeemed prescriptions for methotrexate during the 3 months prior to conception, and two women did so during the pregnancy. One of the four women on leflunomide, received the drug 3 months before conception, and two of them during the first trimester. Among the women using etanercept, 19 women redeemed the prescription 3 months before pregnancy, 11 during the first trimester, one in both the second and third trimesters. Three months prior to conception, 837 expecting fathers (0.8%) redeemed at least one prescription: 40 had sulfasalazin, 36 methotrexate and 28 had biological drugs.
  
  
  CONCLUSIONS
  Three women redeemed leflunomide or methotrexate, which have known teratogenic effects, during their first trimester. While there are high levels of awareness about maternal drug use in pregnancy, drug exposure in fathers shortly before conception should be further explored.
authors.affiliation: Diakonhjemmet Hospital Pharmacy, Oslo and Department of Pharmacotherapeutics, Diakonhjemmet Hospital Pharmacy, Faculty of Medicine, University of Oslo, Oslo, Norway. k.k.viktil@medisin.uio.no
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Viktil
authors.forename: Anders
authors.initials: A
authors.lastname: Engeland
authors.forename: Kari
authors.initials: K
authors.lastname: Furu
mesh_terms: D000293:Adolescent; D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D005220:Fathers / Q000706:statistics & numerical data*; D005260:Female; D005333:Fetus / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009035:Mothers / Q000706:statistics & numerical data*; D009664:Norway / Q000453:epidemiology; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced*; D012042:Registries; D018570:Risk Assessment; D013997:Time Factors; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents