Exposure to potentially teratogenic medications before and during the first trimester of pregnancy compared to women of childbearing age: A retrospective analysis of Swiss claims data (2015–2021)

IF 3.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Carole A. Marxer, Sereina M. Graber, Daniel Surbek, Alice Panchaud, Christoph R. Meier, Julia Spoendlin
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引用次数: 0

Abstract

Introduction

Exposure to potentially teratogenic medications during pregnancy is underinvestigated in Switzerland. We aimed to assess exposure to potential teratogens preconceptionally, during the first trimester, and in women of childbearing age, and specifically explore the effectiveness of the valproate pregnancy prevention program (2018).

Material and Methods

Retrospective study using the Swiss Helsana claims database. In a pregnancy cohort (2015–2021) and a cohort of women of childbearing age (2021 and 2018), we defined three 90-day time periods: (1) first trimester, (2) preconceptional period (days 180–90 before pregnancy), and (3) January 01, 2021, and March 31, 2021 (women of childbearing age). During all periods, we quantified the exposure prevalence to at least one dispensed weak, proven, and unequivocally potent teratogen overall and by age strata. We quantified the exposure prevalence to each individual teratogen, and to valproate during pregnancy by calendar year to compare its use before and after the introduction of a pregnancy prevention program (2018). We investigated the use of systemic retinoids particularly isotretinoin in women of childbearing age.

Results

Of 34 584 pregnant women, 1.4% were exposed to potential teratogens during the first trimester (weak: 1.3%, proven: 0.06%, unequivocally potent: 0.04%). During the preconceptional period, 2.9% were exposed to any teratogen compared to 4.7% of women of childbearing age (Ntotal = 95 059). Systemic glucocorticoids were the most prevalent weak teratogens during all time periods (75% of all claimed teratogens during the first trimester). In the first trimester, the antibiotic cotrimoxazole and the thyreostatic thiamazole (weak teratogens), ranked second and third, followed by the antiseizure medications carbamazepine and topiramate (proven teratogens). Among women of childbearing age, exposure to weak and proven teratogens increased with age, whereas exposure to unequivocally potent teratogens decreased with age. This was due to 2.3% of women <26 years who claimed systemic isotretinoin. Valproate use during pregnancy decreased after the introduction of a pregnancy prevention program (2.39/10 000 pregnancies [2015–2018] vs. 0.93/10 000 pregnancies [2019–2021]).

Conclusions

Most medications with potential teratogenic effects dispensed to women of childbearing age and pregnant women were in the group of weak teratogenicity level, and many women discontinued treatment before pregnancy. Preliminary evidence suggests the valproate pregnancy prevention program in Switzerland may be beneficial.

Abstract Image

与育龄妇女相比,怀孕前和怀孕前三个月期间暴露于潜在致畸药物:瑞士索赔数据(2015-2021)的回顾性分析。
在瑞士,怀孕期间暴露于潜在致畸药物的调查不足。我们的目的是评估孕前、妊娠早期和育龄妇女接触潜在致畸物的情况,并特别探讨丙戊酸酯预防妊娠计划的有效性(2018年)。材料和方法:使用瑞士Helsana索赔数据库进行回顾性研究。在妊娠队列(2015-2021)和育龄妇女队列(2021年和2018年)中,我们定义了三个90天的时间段:(1)妊娠早期,(2)孕前期(怀孕前180-90天),以及(3)2021年1月1日至2021年3月31日(育龄妇女)。在所有时期,我们量化了暴露于至少一种分散的弱的、已证实的和明确有效的致畸物的流行程度,并按年龄层进行了分类。我们按日历年量化了妊娠期间对每种致畸物和丙戊酸盐的暴露率,以比较其在引入妊娠预防计划(2018年)前后的使用情况。我们调查了育龄妇女使用系统性维甲酸特别是异维甲酸的情况。结果:在34 584名孕妇中,1.4%在妊娠早期暴露于潜在的致畸物(弱胎:1.3%,证实胎:0.06%,明确有效胎:0.04%)。在孕前期间,2.9%的妇女接触过致畸剂,而育龄妇女的这一比例为4.7% (Ntotal = 95059)。全身性糖皮质激素是所有时间段内最普遍的弱致畸物(在妊娠早期所有声称的致畸物中占75%)。在妊娠早期,抗生素复方新诺明和促甲状腺激素噻马唑(弱致畸剂)分别排在第二和第三位,其次是抗癫痫药物卡马西平和托吡酯(已证实是致畸剂)。在育龄妇女中,暴露于弱致畸剂和已证实的致畸剂随着年龄的增长而增加,而暴露于明确有效的致畸剂则随着年龄的增长而减少。结论:大多数分配给育龄妇女和孕妇的具有潜在致畸作用的药物属于弱致畸水平组,许多妇女在怀孕前停止治疗。初步证据表明,瑞士的丙戊酸预防妊娠项目可能是有益的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.00
自引率
4.70%
发文量
180
审稿时长
3-6 weeks
期刊介绍: Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.
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