title: Prescribing of Antidiabetic Medicines before, during and after Pregnancy: A Study in Seven European Regions.
abstract: To explore antidiabetic medicine prescribing to women before, during and after pregnancy in different regions of Europe.
  
  
  
  A common protocol was implemented across seven databases in Denmark, Norway, The Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK. Women with a pregnancy starting and ending between 2004 and 2010, (Denmark, 2004-2009; Norway, 2005-2010; Emilia Romagna, 2008-2010), which ended in a live or stillbirth, were identified. Prescriptions for antidiabetic medicines issued (UK) or dispensed (non-UK) during pregnancy and/or the year before or year after pregnancy were identified. Prescribing patterns were compared across databases and over calendar time.
  
  
  
  1,082,673 live/stillbirths were identified. Pregestational insulin prescribing during the year before pregnancy ranged from 0.27% (CI95 0.25-0.30) in Tuscany to 0.45% (CI95 0.43-0.47) in Norway, and increased between 2004 and 2009 in all countries. During pregnancy, insulin prescribing peaked during the third trimester and increased over time; third trimester prescribing was highest in Tuscany (2.2%) and lowest in Denmark (0.5%). Of those prescribed an insulin during pregnancy, between 50.5% in Denmark and 88.8% in the Netherlands received an insulin analogue alone or in combination with human insulin, this proportion increasing over time. Oral products were mainly metformin and prescribing was highest in the 3 months before pregnancy. Metformin use during pregnancy increased in some countries.
  
  
  
  Pregestational diabetes is increasing in many areas of Europe. There is considerable variation between and within countries in the choice of medication for treating pregestational diabetes in pregnancy, including choice of insulin analogues and oral antidiabetics, and very large variation in the treatment of gestational diabetes despite international guidelines.
authors.affiliation: Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Charlton
authors.affiliation: Medical Birth Registry, The Norwegian Institute of Public Health, Bergen, Norway.|Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Kari
authors.initials: K
authors.lastname: Klungsøyr
authors.affiliation: IMER (Emilia Romagna Registry of Birth Defects), Center for Clinical and Epidemiological Research, University of Ferrara, Ferrara, Italy.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Neville
authors.affiliation: Department of Nursing, College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom.
authors.forename: Sue
authors.initials: S
authors.lastname: Jordan
authors.affiliation: Institute of Clinical Physiology-National Research Council (IFC-CNR), Pisa, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Pierini
authors.affiliation: Pharmacoepidemiology and Pharmacoeconomics unit, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
authors.forename: Lolkje T W
authors.initials: LT
authors.lastname: de Jong-van den Berg
authors.affiliation: Pharmacoepidemiology and Pharmacoeconomics unit, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
authors.forename: H Jens
authors.initials: HJ
authors.lastname: Bos
authors.affiliation: Drug Policy Service, Emilia Romagna Region Health Authority, Bologna, Italy.
authors.forename: Aurora
authors.initials: A
authors.lastname: Puccini
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.|Department of Pharmacoepidemiology, The Norwegian Institute of Public Health, Bergen, Norway.
authors.forename: Anders
authors.initials: A
authors.lastname: Engeland
authors.affiliation: Agenzia Regionale di Sanità della Toscana, Florence, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Gini
authors.affiliation: Centre for Health Information, Research and Evaluation, Swansea University, Swansea, Wales, United Kingdom.
authors.forename: Gareth
authors.initials: G
authors.lastname: Davies
authors.affiliation: Centre for Health Information, Research and Evaluation, Swansea University, Swansea, Wales, United Kingdom.
authors.forename: Daniel
authors.initials: D
authors.lastname: Thayer
authors.affiliation: Paediatric department, Hospital Lillebaelt, Kolding, Denmark.
authors.forename: Anne V
authors.initials: AV
authors.lastname: Hansen
authors.affiliation: CARIS, The Congenital Anomaly Register for Wales, Singleton Hospital, Swansea, United Kingdom.
authors.forename: Margery
authors.initials: M
authors.lastname: Morgan
authors.affiliation: Pharmacoepidemiology and Pharmacoeconomics unit, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom.
authors.forename: Anita
authors.initials: A
authors.lastname: McGrogan
authors.affiliation: Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Nybo Andersen
authors.affiliation: Centre for Maternal, Fetal and Infant Research, Institute for Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Dolk
authors.affiliation: Paediatric department, Hospital Lillebaelt, Kolding, Denmark.
authors.forename: Ester
authors.initials: E
authors.lastname: Garne
mesh_terms: D000328:Adult; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000188:drug therapy / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D011159:Population Surveillance; D011247:Pregnancy; D015995:Prevalence
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin