title: Prevalence of prescribing in pregnancy using the Irish primary care research network: a pilot study.
abstract: BACKGROUND
  To establish the prevalence and patterns of prescribing to pregnant women in an Irish primary care setting.
  
  
  METHODS
  We reviewed electronic healthcare records routinely collected in primary care, of pregnant women attending nine Dublin-based General Practices affiliated to the Irish Primary Care Research Network (IPCRN) for antenatal care between January 2007 and October 2013 (n = 2,361 pregnancies).
  
  
  RESULTS
  Excluding folic acid, 46.8% (n = 1,104) of pregnant women were prescribed at least one medication. Amoxicillin (11.1%, n = 263) and co-amoxiclav (8.0%, n = 190) were the most commonly prescribed medication followed by topical clotrimazole (4.9%, n = 117), salbutamol inhalers (4.1%, n = 96) and paracetamol (4.0%, n = 95). General Medical Services (GMS) patients were more likely to receive a prescription than private patients (OR 2.81; 95%CI (2.28, 3.47)). We applied the US FDA pregnancy-risk categories as a proxy measure of prescribing appropriateness, with FDA Category D and X medications considered inappropriate. FDA Category D drugs were prescribed in 5.9% (n = 140) of pregnancies. FDA Category X drugs were prescribed in 4.9% (n = 116) of pregnancies but after exclusion of oral contraceptives, progestogens, infertility treatments Category X medications were prescribed in 0.6% (n = 13) of pregnancies. After the initial antenatal consultation the prescribing prevalence of FDA Category D medications reduced to 4.7% (n = 110) and Category X to 3.1% (n = 72).
  
  
  CONCLUSIONS
  The overall prevalence of prescribing to pregnant women in our cohort is low compared to studies internationally, however similar levels of prescribing for FDA Category D and X were found. Following the initial antenatal consultation levels of prescribing of the FDA Category D and X medications reduced, however there is potential to further reduce their use in early pregnancy. The IPCRN database has provided valuable information on the current practice of antenatal prescribing within this pilot group of practices however it is limited by the absence of morbidity and pregnancy outcome data.
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland. pauldillon@rcsi.ie.
authors.forename: Paul
authors.initials: P
authors.lastname: Dillon
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland. kirstyobrien@rcsi.ie.
authors.forename: Kirsty K
authors.initials: KK
authors.lastname: O'Brien
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland. rmcdonnell@rcsi.ie.
authors.forename: Ronan
authors.initials: R
authors.lastname: McDonnell
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland. ericadswift@rcsi.ie.
authors.forename: Erica
authors.initials: E
authors.lastname: Donnelly-Swift
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland. rosegalvin@rcsi.ie.
authors.forename: Rose
authors.initials: R
authors.lastname: Galvin
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland. adamroche@rcsi.ie.
authors.forename: Adam
authors.initials: A
authors.lastname: Roche
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland. katecronin@rcsi.ie.
authors.forename: Kate
authors.initials: K
authors.lastname: Cronin
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland. davidrwalsh@rcsi.ie.
authors.forename: David R
authors.initials: DR
authors.lastname: Walsh
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland. rowanschelten@rcsi.ie.
authors.forename: Rowan
authors.initials: R
authors.lastname: Schelten
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland. susansmith@rcsi.ie.
authors.forename: Susan
authors.initials: S
authors.lastname: Smith
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland. tomfahey@rcsi.ie.
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
mesh_terms: D000328:Adult; D015331:Cohort Studies; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D018566:Pregnancy, High-Risk; D037841:Pregnant People; D011295:Prenatal Care / Q000379:methods / Q000706:statistics & numerical data; D055553:Prescription Drugs / Q000145:classification / Q000627:therapeutic use; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D055553:Prescription Drugs