Prescription medication use during pregnancy in the United States from 2011 to 2020: trends and safety evidence - 16/01/24
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Abstract |
Background |
Medication use during pregnancy has increased in the United States despite the lack of safety data for many medications.
Objective |
This study aimed to inform research priorities by examining trends in medication use during pregnancy and identifying gaps in safety information on the most commonly prescribed medications.
Study Design |
We identified population-based cohorts of commercially (MarketScan 2011–2020) and publicly (Medicaid Analytic eXtract/Transformed Medicaid Statistical Information System Analytic Files 2011–2018) insured pregnancies ending in live birth from 2 health care utilization databases. Medication use was based on filled prescriptions between the date of last menstrual period through delivery, as well as the period before the last menstrual period and during specific trimesters. We also included a cross-sectional representative sample of pregnancies ascertained by the National Health and Nutrition Examination Survey (2011–2020), with information on prescription medication use during the preceding month obtained through maternal interviews. Teratogen Information System was used to classify the available evidence on teratogenic risk.
Results |
Among over 3 million pregnancies, the medications most commonly dispensed at any time during pregnancy were analgesics, antibiotics, and antiemetics. The top medications were ondansetron (16.8%), amoxicillin (13.5%), and azithromycin (12.4%) in MarketScan, nitrofurantoin (22.2%), acetaminophen (21.3%; mostly as part of acetaminophen–hydrocodone products), and ondansetron (19.5%) in Medicaid Analytic eXtract/Transformed Medicaid Statistical Information System Analytic Files, and levothyroxine (5.0%), sertraline (2.9%), and insulin (2.9%) in the National Health and Nutrition Examination Survey group. The most commonly dispensed suspected teratogens during the first trimester were antithyroid medications. The use of antidiabetic and psychotropic medications has continued to increase in the United States during the last decade, opioid dispensation has decreased by half, and antibiotics and antiemetics continue to be common. For one-quarter of medications, there is insufficient evidence available to characterize their safety profile in pregnancy.
Conclusion |
There is a need for more drug research in pregnant patients. Future research should focus on anti-infectives with high utilization and limited level of evidence on safety for use during pregnancy. Although lack of evidence is not evidence of safety concerns, it does not indicate risk either. In many instances, the benefits outweigh the risks when these medications are used clinically, and some of the medications with no proven safety may be necessary to treat patients.
Le texte complet de cet article est disponible en PDF.Key words : gestation, perinatal, pharmacoepidemiology, teratogens, TERIS, utilization
Plan
K.J.G. reports consulting for BillionToOne, Aetion, and Roche outside the scope of the submitted work. K.F.H. reports being an investigator on grants to her institution from Takeda and UCB for unrelated work. S.H.D. was an investigator for research grants from Takeda to her institution for unrelated products. The remaining authors report no conflict of interest. |
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This work was supported by grant R01 HD097778 from the National Institute of Child Health and Development (NICHD). This work was supported by grant R01 HD097778 from the Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD). L.S. was supported by a training grant from NICHD (T32HD040128), which had no role in any aspect of the study or its submission. |
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Partial results of this study were presented at the 39th International Conference on Pharmacoepidemiology & Therapeutic Risk Management of the International Society for Pharmacoepidemiology, Halifax, Canada, August 23–27, 2023. |
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Cite this article as: Mansour O, Russo RG, Straub L, et al. Prescription medication use during pregnancy in the United States from 2011 to 2020: trends and safety evidence. Am J Obstet Gynecol 2023;XX:x.ex–x.ex. |
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