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Prescription drug use in pregnancy

  • Susan E. Andrade
    Correspondence
    Reprint requests: Susan E. Andrade, ScD, Meyers Primary Care Institute, 630 Plantation St, Worcester, MA 01605.
    Affiliations
    Meyers Primary Care Institute-Fallon Healthcare System and University of Massachusetts Medical School, Worcester, Massa; Center for Health Studies, Group Health Cooperative, Seattle, Washb; Channing Laboratory, Brigham and Women's Hospital, Boston, Massc; Department of Epidemiology, Harvard School of Public Health, Boston, Massd; Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Masse; HealthPartners Research Foundation, Minneapolis, Minnf; Kaiser Permanente Colorado, Denver, Colog; Kaiser Permanente Georgia, Atlanta, Gah; Kaiser Permanente Northwest, Portland, Orei; Henry Ford Health Systems, Detroit, Michj; The HMO Research Network Center for Education and Research in Therapeuticsk USA
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  • Jerry H. Gurwitz
    Affiliations
    Meyers Primary Care Institute-Fallon Healthcare System and University of Massachusetts Medical School, Worcester, Massa; Center for Health Studies, Group Health Cooperative, Seattle, Washb; Channing Laboratory, Brigham and Women's Hospital, Boston, Massc; Department of Epidemiology, Harvard School of Public Health, Boston, Massd; Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Masse; HealthPartners Research Foundation, Minneapolis, Minnf; Kaiser Permanente Colorado, Denver, Colog; Kaiser Permanente Georgia, Atlanta, Gah; Kaiser Permanente Northwest, Portland, Orei; Henry Ford Health Systems, Detroit, Michj; The HMO Research Network Center for Education and Research in Therapeuticsk USA
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  • Robert L. Davis
    Affiliations
    Meyers Primary Care Institute-Fallon Healthcare System and University of Massachusetts Medical School, Worcester, Massa; Center for Health Studies, Group Health Cooperative, Seattle, Washb; Channing Laboratory, Brigham and Women's Hospital, Boston, Massc; Department of Epidemiology, Harvard School of Public Health, Boston, Massd; Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Masse; HealthPartners Research Foundation, Minneapolis, Minnf; Kaiser Permanente Colorado, Denver, Colog; Kaiser Permanente Georgia, Atlanta, Gah; Kaiser Permanente Northwest, Portland, Orei; Henry Ford Health Systems, Detroit, Michj; The HMO Research Network Center for Education and Research in Therapeuticsk USA
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  • K.Arnold Chan
    Affiliations
    Meyers Primary Care Institute-Fallon Healthcare System and University of Massachusetts Medical School, Worcester, Massa; Center for Health Studies, Group Health Cooperative, Seattle, Washb; Channing Laboratory, Brigham and Women's Hospital, Boston, Massc; Department of Epidemiology, Harvard School of Public Health, Boston, Massd; Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Masse; HealthPartners Research Foundation, Minneapolis, Minnf; Kaiser Permanente Colorado, Denver, Colog; Kaiser Permanente Georgia, Atlanta, Gah; Kaiser Permanente Northwest, Portland, Orei; Henry Ford Health Systems, Detroit, Michj; The HMO Research Network Center for Education and Research in Therapeuticsk USA
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  • Jonathan A. Finkelstein
    Affiliations
    Meyers Primary Care Institute-Fallon Healthcare System and University of Massachusetts Medical School, Worcester, Massa; Center for Health Studies, Group Health Cooperative, Seattle, Washb; Channing Laboratory, Brigham and Women's Hospital, Boston, Massc; Department of Epidemiology, Harvard School of Public Health, Boston, Massd; Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Masse; HealthPartners Research Foundation, Minneapolis, Minnf; Kaiser Permanente Colorado, Denver, Colog; Kaiser Permanente Georgia, Atlanta, Gah; Kaiser Permanente Northwest, Portland, Orei; Henry Ford Health Systems, Detroit, Michj; The HMO Research Network Center for Education and Research in Therapeuticsk USA
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  • Kris Fortman
    Affiliations
    Meyers Primary Care Institute-Fallon Healthcare System and University of Massachusetts Medical School, Worcester, Massa; Center for Health Studies, Group Health Cooperative, Seattle, Washb; Channing Laboratory, Brigham and Women's Hospital, Boston, Massc; Department of Epidemiology, Harvard School of Public Health, Boston, Massd; Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Masse; HealthPartners Research Foundation, Minneapolis, Minnf; Kaiser Permanente Colorado, Denver, Colog; Kaiser Permanente Georgia, Atlanta, Gah; Kaiser Permanente Northwest, Portland, Orei; Henry Ford Health Systems, Detroit, Michj; The HMO Research Network Center for Education and Research in Therapeuticsk USA
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  • Heather McPhillips
    Affiliations
    Meyers Primary Care Institute-Fallon Healthcare System and University of Massachusetts Medical School, Worcester, Massa; Center for Health Studies, Group Health Cooperative, Seattle, Washb; Channing Laboratory, Brigham and Women's Hospital, Boston, Massc; Department of Epidemiology, Harvard School of Public Health, Boston, Massd; Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Masse; HealthPartners Research Foundation, Minneapolis, Minnf; Kaiser Permanente Colorado, Denver, Colog; Kaiser Permanente Georgia, Atlanta, Gah; Kaiser Permanente Northwest, Portland, Orei; Henry Ford Health Systems, Detroit, Michj; The HMO Research Network Center for Education and Research in Therapeuticsk USA
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  • Marsha A. Raebel
    Affiliations
    Meyers Primary Care Institute-Fallon Healthcare System and University of Massachusetts Medical School, Worcester, Massa; Center for Health Studies, Group Health Cooperative, Seattle, Washb; Channing Laboratory, Brigham and Women's Hospital, Boston, Massc; Department of Epidemiology, Harvard School of Public Health, Boston, Massd; Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Masse; HealthPartners Research Foundation, Minneapolis, Minnf; Kaiser Permanente Colorado, Denver, Colog; Kaiser Permanente Georgia, Atlanta, Gah; Kaiser Permanente Northwest, Portland, Orei; Henry Ford Health Systems, Detroit, Michj; The HMO Research Network Center for Education and Research in Therapeuticsk USA
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  • Douglas Roblin
    Affiliations
    Meyers Primary Care Institute-Fallon Healthcare System and University of Massachusetts Medical School, Worcester, Massa; Center for Health Studies, Group Health Cooperative, Seattle, Washb; Channing Laboratory, Brigham and Women's Hospital, Boston, Massc; Department of Epidemiology, Harvard School of Public Health, Boston, Massd; Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Masse; HealthPartners Research Foundation, Minneapolis, Minnf; Kaiser Permanente Colorado, Denver, Colog; Kaiser Permanente Georgia, Atlanta, Gah; Kaiser Permanente Northwest, Portland, Orei; Henry Ford Health Systems, Detroit, Michj; The HMO Research Network Center for Education and Research in Therapeuticsk USA
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  • David H. Smith
    Affiliations
    Meyers Primary Care Institute-Fallon Healthcare System and University of Massachusetts Medical School, Worcester, Massa; Center for Health Studies, Group Health Cooperative, Seattle, Washb; Channing Laboratory, Brigham and Women's Hospital, Boston, Massc; Department of Epidemiology, Harvard School of Public Health, Boston, Massd; Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Masse; HealthPartners Research Foundation, Minneapolis, Minnf; Kaiser Permanente Colorado, Denver, Colog; Kaiser Permanente Georgia, Atlanta, Gah; Kaiser Permanente Northwest, Portland, Orei; Henry Ford Health Systems, Detroit, Michj; The HMO Research Network Center for Education and Research in Therapeuticsk USA
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  • Marianne Ulcickas Yood
    Affiliations
    Meyers Primary Care Institute-Fallon Healthcare System and University of Massachusetts Medical School, Worcester, Massa; Center for Health Studies, Group Health Cooperative, Seattle, Washb; Channing Laboratory, Brigham and Women's Hospital, Boston, Massc; Department of Epidemiology, Harvard School of Public Health, Boston, Massd; Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Masse; HealthPartners Research Foundation, Minneapolis, Minnf; Kaiser Permanente Colorado, Denver, Colog; Kaiser Permanente Georgia, Atlanta, Gah; Kaiser Permanente Northwest, Portland, Orei; Henry Ford Health Systems, Detroit, Michj; The HMO Research Network Center for Education and Research in Therapeuticsk USA
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  • Abraham N. Morse
    Affiliations
    Meyers Primary Care Institute-Fallon Healthcare System and University of Massachusetts Medical School, Worcester, Massa; Center for Health Studies, Group Health Cooperative, Seattle, Washb; Channing Laboratory, Brigham and Women's Hospital, Boston, Massc; Department of Epidemiology, Harvard School of Public Health, Boston, Massd; Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Masse; HealthPartners Research Foundation, Minneapolis, Minnf; Kaiser Permanente Colorado, Denver, Colog; Kaiser Permanente Georgia, Atlanta, Gah; Kaiser Permanente Northwest, Portland, Orei; Henry Ford Health Systems, Detroit, Michj; The HMO Research Network Center for Education and Research in Therapeuticsk USA
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  • Richard Platt
    Affiliations
    Meyers Primary Care Institute-Fallon Healthcare System and University of Massachusetts Medical School, Worcester, Massa; Center for Health Studies, Group Health Cooperative, Seattle, Washb; Channing Laboratory, Brigham and Women's Hospital, Boston, Massc; Department of Epidemiology, Harvard School of Public Health, Boston, Massd; Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Masse; HealthPartners Research Foundation, Minneapolis, Minnf; Kaiser Permanente Colorado, Denver, Colog; Kaiser Permanente Georgia, Atlanta, Gah; Kaiser Permanente Northwest, Portland, Orei; Henry Ford Health Systems, Detroit, Michj; The HMO Research Network Center for Education and Research in Therapeuticsk USA
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      Abstract

      Objective

      The purpose of this study was to provide information on the prevalence of the use of prescription drugs among pregnant women in the United States.

      Study design

      A retrospective study was conducted with the use of the automated databases of 8 health maintenance organizations that are involved in the Health Maintenance Research Network Center for Education and Research on Therapeutics. Women who delivered of an infant in a hospital from January 1, 1996, through December 31, 2000, were identified. Prescription drug use according to therapeutic class and the United States Food and Drug Administration risk classification system was evaluated, with the assumption of a gestational duration of 270 days, with three 90-day trimesters of pregnancy, and with a 90-day period before pregnancy. Nonprescription drug use was not assessed.

      Results

      During the period 1996 through 2000, 152,531 deliveries were identified that met the criteria for study. For 98,182 deliveries (64%), a drug other than a vitamin or mineral supplement was prescribed in the 270 days before delivery: 3595 women (2.4%) received a drug from category A; 76,292 women (50.0%) received a drug from category B; 57,604 women (37.8%) received a drug from category C; 7333 women (4.8%) received a drug from category D, and 6976 women (4.6%) received a drug from category X of the United States Food and Drug Administration risk classification system. Overall, 5157 women (3.4%) received a category D drug, and 1653 women (1.1%) received a category X drug after the initial prenatal care visit.

      Conclusion

      Our finding that almost one half of all pregnant women received prescription drugs from categories C, D, or X of the United States Food and Drug Administration risk classification system highlights the importance of the need to understand the effects of these medications on the developing fetus and on the pregnant woman.

      Keywords

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      References

        • Haramburu F.
        • Miremont-Salame G.
        • Moore N.
        Good and bad prescription in pregnancy.
        Lancet. 2000; 356: 1704
        • Olesen C.
        • Steffensen F.H.
        • Nielsen G.L.
        • de Jong-van den Berg L.
        • Olsen J.
        • Sorensen H.T.
        • the Euromap group
        Drug use in first pregnancy and lactation: a population-based survey among Danish women.
        Eur J Clin Pharmacol. 1999; 55: 139-144
        • Rubin J.D.
        • Ferencz C.
        • Loffredo C.
        • the Baltimore-Washington Infant Study Group
        Use of prescription and non-prescription drugs in pregnancy.
        J Clin Epidemiol. 1993; 46: 581-589
        • Brocklebank J.C.
        • Ray W.A.
        • Federspiel C.F.
        • Schaffner W.
        Drug prescribing during pregnancy: a controlled study of Tennessee Medicaid recipients.
        Am J Obstet Gynecol. 1978; 132: 235-244
        • Piper J.M.
        • Baum C.
        • Kennedy D.L.
        Prescription drug use before and during pregnancy in a Medicaid population.
        Am J Obstet Gynecol. 1987; 157: 148-156
        • Buitendijk S.
        • Bracken M.B.
        Medication in early pregnancy: prevalence of use and relationship to maternal characteristics.
        Am J Obstet Gynecol. 1991; 165: 33-40
        • Piper J.M.
        • Baum C.
        • Kennedy D.L.
        • Price P.
        Maternal use of prescribed drugs associated with recognized fetal adverse drug reactions.
        Am J Obstet Gynecol. 1988; 159: 1173-1177
        • Bonati M.
        • Bortolus R.
        • Marchetti F.
        • Romero M.
        • Tognoni G.
        Drug use in pregnancy: an overview of epidemiological (drug utilization) studies.
        Eur J Clin Pharmacol. 1990; 38: 325-328
        • Collaborative Group on Drug Use in Pregnancy
        Medication during pregnancy: an intercontinental cooperative study.
        Int J Gynecol Obstet. 1992; 39: 185-196
        • Donati S.
        • Baglio G.
        • Spinelli A.
        • Grandolfo M.E.
        Drug use in pregnancy among Italian women.
        Eur J Clin Pharmacol. 2000; 56: 323-328
        • Lacroix I.
        • Damase-Michel C.
        • Lapeyre-Mestre M.
        • Montastruc J.L.
        Prescription of drugs during pregnancy in France.
        Lancet. 2000; 356: 1735-1736
        • Olesen C.
        • Sorensen H.T.
        • de Jong-van den Berg L.
        • Olsen J.
        • Steffensen F.H.
        • the Euromap Group
        Prescribing during pregnanacy and lactation with reference to the Swedish classification system: a population-based study among Danish women.
        Acta Obstet Gynecol Scand. 1999; 78: 686-692
      1. Classification of medicinal products for use during pregnancy and lactation: the Swedish systems. LINFO, Drug Information Ltd, Kungsbacka, Sweden1993
        • Briggs G.G.
        • Freeman R.K.
        • Yaffe S.J.
        A reference guide to fetal and neonatal risk- drugs in pregnancy and lactation.
        5th ed. Lippincott Williams & Wilkins, Philadephia1998
        • Splinter M.Y.
        • Sagraves R.
        • Nightengale B.
        • Rayburn W.F.
        Prenatal use of medications by women giving birth at a university hospital.
        South Med J. 1997; 90: 498-502
        • Doering P.L.
        • Boothby L.A.
        • Cheok M.
        Review of pregnancy labeling of prescription drugs: Is the current system adequate to inform of risks?.
        Am J Obstet Gynecol. 2002; 187: 333-339
      2. Shojania K. Duncan B. McDonald K. Wachter R.M. Making health care safer: a critical analysis of patient safety practices. Evidence report/technology assessment no. 43; AJRQ publication 01-E058. Agency for Healthcare Research and Quality, Rockville (MD)2001