title: Assessing the information in the Summaries of Product Characteristics for the use of medicines in pregnancy and lactation.
abstract: OBJECTIVE
  To assess the completeness and applicability of information for the use of medicines in pregnancy and lactation contained in European Summaries of Product Characteristics (SmPCs).
  
  
  METHODS
  SmPCs available on the EMA website in April 2011 were retrieved, and information on the use of medicines during pregnancy and lactation was analyzed. A form was designed to extract information regarding drug concentrations crossing the placenta, excretion of the drug in milk, the existence of pre-clinical and clinical studies and clinical experience describing the use of the medicine in pregnancy and lactation, medicine effects on human fertility, medicines use in women of child-bearing potential and specific recommendations for use during pregnancy and breastfeeding. SmPCs were classified as containing 'conclusive' or 'ambiguous' information depending on whether (or not) they provided clear instructions regarding medicine use in pregnancy and lactation.
  
  
  RESULTS
  Of the 534 SmPCs, 89.3% did not mention whether the drug crossed the placenta, 67.6% indicated that there was no clinical experience during pregnancy and in 61.4% it was unknown whether the medicine was excreted in human milk. Recommendations for medicine use during pregnancy and breastfeeding were ambiguous in 57.0% and 16.5% of the SmPCs, respectively, and medicine use was restricted in over 90% SmPCs for both pregnancy and breastfeeding, despite no information supporting these restrictions being reported. The time elapsed since a SmPCs first approval was not associated with an increase in information quality.
  
  
  CONCLUSIONS
  Important information deficits on the use of medicines during pregnancy and breastfeeding were found in European SmPCs.
authors.affiliation: Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal.
authors.forename: Blanca
authors.initials: B
authors.lastname: Arguello
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Salgado
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernandez-Llimos
mesh_terms: D001942:Breast Feeding; D064420:Drug-Related Side Effects and Adverse Reactions; D005062:European Union; D005260:Female; D006801:Humans; D007774:Lactation / Q000378:metabolism*; D004364:Pharmaceutical Preparations / Q000145:classification / Q000378:metabolism; D010920:Placenta / Q000378:metabolism; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced* / Q000378:metabolism
chemical_list: D004364:Pharmaceutical Preparations
keywords: Summaries of Product Characteristics; clinical decision support systems; drug labelling; lactation; medicines information; pregnancy