Concurrent use of hormonal long-acting reversible contraception by women of reproductive age dispensed teratogenic medications, Australia, 2013–2021: a retrospective cohort study

IF 6.7 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medical Journal of Australia Pub Date : 2024-09-16 DOI:10.5694/mja2.52451

Luke E Grzeskowiak, Vivienne Moore, Kelly Hall, Jenni Ilomäki, Danielle Schoenaker, Elizabeth Lovegrove, Danielle Mazza, Kirsten I Black, Debra S Kennedy, Michael J Davies, Alice Rumbold

{"title":"Concurrent use of hormonal long-acting reversible contraception by women of reproductive age dispensed teratogenic medications, Australia, 2013–2021: a retrospective cohort study","authors":"Luke E Grzeskowiak, Vivienne Moore, Kelly Hall, Jenni Ilomäki, Danielle Schoenaker, Elizabeth Lovegrove, Danielle Mazza, Kirsten I Black, Debra S Kennedy, Michael J Davies, Alice Rumbold","doi":"10.5694/mja2.52451","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>To examine patterns in the dispensing of category X medications (Therapeutic Goods Administration categorisation system for prescribing medicines in pregnancy) to women aged 15–49 years in Australia during 2008–2021, and patterns of concurrent use of hormonal long-acting reversible contraception (LARC) and other hormonal contraception.</p>\n </section>\n \n <section>\n \n <h3> Study design</h3>\n \n <p>Retrospective cohort study; analysis of 10% random sample of national Pharmaceutical Benefits Scheme dispensing data.</p>\n </section>\n \n <section>\n \n <h3> Participants, setting</h3>\n \n <p>Women aged 15–49 years dispensed category X medications, Australia, 1 January 2013 – 31 December 2021.</p>\n </section>\n \n <section>\n \n <h3> Main outcome measures</h3>\n \n <p>Incident and prevalent dispensing of category X medications, by medication class, age group, and year; contraceptive overlap (proportions of women dispensed hormonal LARC or other hormonal contraception that overlapped the first dispensing of category X medications), by medication class.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 15 627 women aged 15–49 years dispensed category X medications during 2013–2021, the prevalence of dispensing increased from 4.6 in 2013 to 8.7 per 1000 women aged 15–49 years in 2021; the largest increase was for the dispensing of dermatological agents, from 3.9 to 7.9 per 1000 women aged 15–49 years. LARC overlap was inferred for 2059 women at the time of first dispensing of category X medications (13.2%); 3441 had been dispensed any type of hormonal contraception (22.1%). The proportion with LARC overlap was smallest for those dispensed dermatological agents (1806 of 14 331 women, 12.6%); for this drug class, both LARC overlap (adjusted odds ratio [aOR], 0.17; 95% confidence interval [CI], 0.14–0.20) and any hormonal contraception overlap (aOR, 0.28; 95% CI, 0.25–0.32) were less likely for those aged 15–19 years than for women aged 25–29 years.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Concurrent use of highly effective hormonal contraception at the time of first dispensing of category X medications is low in Australia, raising concerns about potential fetal harms during unintended pregnancies. Awareness of the importance of hormonal contraception and its uptake by women prescribed category X medications should be increased.</p>\n </section>\n </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 7","pages":"367-373"},"PeriodicalIF":6.7000,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52451","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medical Journal of Australia","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.5694/mja2.52451","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

To examine patterns in the dispensing of category X medications (Therapeutic Goods Administration categorisation system for prescribing medicines in pregnancy) to women aged 15–49 years in Australia during 2008–2021, and patterns of concurrent use of hormonal long-acting reversible contraception (LARC) and other hormonal contraception.

Study design

Retrospective cohort study; analysis of 10% random sample of national Pharmaceutical Benefits Scheme dispensing data.

Participants, setting

Women aged 15–49 years dispensed category X medications, Australia, 1 January 2013 – 31 December 2021.

Main outcome measures

Incident and prevalent dispensing of category X medications, by medication class, age group, and year; contraceptive overlap (proportions of women dispensed hormonal LARC or other hormonal contraception that overlapped the first dispensing of category X medications), by medication class.

Results

Among 15 627 women aged 15–49 years dispensed category X medications during 2013–2021, the prevalence of dispensing increased from 4.6 in 2013 to 8.7 per 1000 women aged 15–49 years in 2021; the largest increase was for the dispensing of dermatological agents, from 3.9 to 7.9 per 1000 women aged 15–49 years. LARC overlap was inferred for 2059 women at the time of first dispensing of category X medications (13.2%); 3441 had been dispensed any type of hormonal contraception (22.1%). The proportion with LARC overlap was smallest for those dispensed dermatological agents (1806 of 14 331 women, 12.6%); for this drug class, both LARC overlap (adjusted odds ratio [aOR], 0.17; 95% confidence interval [CI], 0.14–0.20) and any hormonal contraception overlap (aOR, 0.28; 95% CI, 0.25–0.32) were less likely for those aged 15–19 years than for women aged 25–29 years.

Conclusions

Concurrent use of highly effective hormonal contraception at the time of first dispensing of category X medications is low in Australia, raising concerns about potential fetal harms during unintended pregnancies. Awareness of the importance of hormonal contraception and its uptake by women prescribed category X medications should be increased.

Abstract Image

查看原文本刊更多论文

2013-2021年澳大利亚育龄妇女同时使用激素类长效可逆避孕药的致畸药物：一项回顾性队列研究。

目的调查2008-2021年期间澳大利亚15-49岁女性使用X类药物（治疗商品管理局妊娠处方药分类系统）的模式，以及同时使用激素长效可逆避孕药（LARC）和其他激素避孕药的模式：研究设计：回顾性队列研究；分析全国药品福利计划配药数据的 10% 随机样本：主要结果指标：主要结果测量指标：按药物类别、年龄组和年份分列的X类药物配药事件和配药流行情况；按药物类别分列的避孕药物重叠情况（配发激素类LARC或其他激素类避孕药物的女性与首次配发X类药物重叠的比例）：在 2013-2021 年期间配发 X 类药物的 15 627 名 15-49 岁女性中，配发率从 2013 年的每千名 15-49 岁女性 4.6 例增至 2021 年的 8.7 例；增幅最大的是皮肤病药物配发，从每千名 15-49 岁女性 3.9 例增至 7.9 例。在首次配发 X 类药物时，有 2059 名妇女（13.2%）推断出 LARC 重叠；有 3441 名妇女（22.1%）配发过任何类型的激素避孕药物。在皮肤病药物配药者中，LARC 重叠的比例最小（14 331 名妇女中有 1806 人，占 12.6%）；就这类药物而言，15-19 岁妇女的 LARC 重叠率（调整赔率 [aOR]，0.17；95% 置信区间 [CI]，0.14-0.20）和任何激素避孕药物重叠率（aOR，0.28；95% CI，0.25-0.32）均低于 25-29 岁妇女：结论：在澳大利亚，首次配发 X 类药物时同时使用高效激素避孕药的比例很低，这引起了人们对意外怀孕可能对胎儿造成伤害的担忧。应提高妇女对荷尔蒙避孕重要性的认识，并提高X类药物处方的使用率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Medical Journal of Australia 医学-医学：内科

CiteScore

9.40

自引率

5.30%

发文量

410

审稿时长

3-8 weeks

期刊介绍： The Medical Journal of Australia (MJA) stands as Australia's foremost general medical journal, leading the dissemination of high-quality research and commentary to shape health policy and influence medical practices within the country. Under the leadership of Professor Virginia Barbour, the expert editorial team at MJA is dedicated to providing authors with a constructive and collaborative peer-review and publication process. Established in 1914, the MJA has evolved into a modern journal that upholds its founding values, maintaining a commitment to supporting the medical profession by delivering high-quality and pertinent information essential to medical practice.