Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 154 No. 8 (2024)

Dispensed drugs during pregnancy in outpatient care between 2015 and 2021 in Switzerland: a retrospective analysis of Swiss healthcare claims data

DOI
https://doi.org/10.57187/s.3616
Cite this as:
Swiss Med Wkly. 2024;154:3616
Published
12.08.2024

Summary

AIM OF THE STUDY: We aimed to evaluate the utilisation of all prescribed drugs during pregnancy dispensed in outpatient care in Switzerland between 2015 and 2021.

METHODS: We conducted a descriptive study using the Swiss Helsana claims database (2015-2021). We established a cohort of pregnancies by identifying deliveries and estimating the date of the last menstrual period. We analysed the drug burden during a 270-day pre-pregnancy period, during pregnancy (overall and by trimester), and during a 270-day postpartum period. Subsequently, we quantified 1) the median number of drug dispensations (total vs. unique drug claims); and 2) the prevalence of exposure to at least one dispensed drug and the number of dispensed drugs (0, 1, 2, 3, 4, and ≥5); and 3) the 15 most frequently dispensed drugs were identified during each period, overall and stratified by maternal age.

RESULTS: Among 34,584 pregnant women (5.6% of all successful pregnancies in Switzerland), 87.5% claimed at least one drug (not including vitamins, supplements, and vaccines), and 33.3% claimed at least five drugs during pregnancy. During trimester 1 alone, 8.2% of women claimed at least five distinct drugs. The proportion of women who claimed prescribed drugs was lower pre-pregnancy (69.1%) and similar postpartum (85.6%) when compared to during pregnancy (87.5%). The most frequently claimed drugs during pregnancy were meaningfully different during pregnancy than before and after.

CONCLUSIONS: This study suggests that 8 of 10 women in Switzerland are exposed to prescribed drugs during pregnancy. Most drugs dispensed during pregnancy are comparatively well investigated and are considered safe. However, the high drug burden in this vulnerable patient population underlines the importance of evidence on the benefit-risk profile of individual drugs taken during pregnancy.

References

  1. Frost Widnes SK, Schjøtt J. Advice on drug safety in pregnancy: are there differences between commonly used sources of information? Drug Saf. 2008;31(9):799–806. 10.2165/00002018-200831090-00008 DOI: https://doi.org/10.2165/00002018-200831090-00008
  2. Dashraath P, Nielsen-Saines K, Madhi SA, Baud D. COVID-19 vaccines and neglected pregnancy. Lancet. 2020 Sep;396(10252):e22. 10.1016/S0140-6736(20)31822-5 DOI: https://doi.org/10.1016/S0140-6736(20)31822-5
  3. Noh Y, Yoon D, Song I, Jeong HE, Bae JH, Shin JY. Discrepancies in the Evidence and Recommendation Levels of Pregnancy Information in Prescription Drug Labeling in the United States, United Kingdom, Japan, and Korea. J Womens Health (Larchmt). 2018 Sep;27(9):1086–92. 10.1089/jwh.2017.6792 DOI: https://doi.org/10.1089/jwh.2017.6792
  4. Lupattelli A, Spigset O, Twigg MJ, Zagorodnikova K, Mårdby AC, Moretti ME, et al. Medication use in pregnancy: a cross-sectional, multinational web-based study. BMJ Open. 2014 Feb;4(2):e004365. 10.1136/bmjopen-2013-004365 DOI: https://doi.org/10.1136/bmjopen-2013-004365
  5. Gerbier E, Graber SM, Rauch M, Marxer CA, Meier CR, Baud D, et al. Use of drugs to treat symptoms and acute conditions during pregnancy in outpatient care in Switzerland between 2014 and 2018: analysis of Swiss healthcare claims data. Swiss Med Wkly. 2021 Nov;151(4748):w30048. 10.4414/SMW.2021.w30048
  6. Gerbier E, Graber SM, Rauch M, Marxer CA, Meier CR, Baud D, et al. Use of Prescribed Drugs to Treat Chronic Diseases during Pregnancy in Outpatient Care in Switzerland between 2014 and 2018: Descriptive Analysis of Swiss Health Care Claims Data. Int J Environ Res Public Health. 2022 Jan;19(3):1456. 10.3390/ijerph19031456 DOI: https://doi.org/10.3390/ijerph19031456
  7. Spoendlin J, Blozik E, Graber S, Rauch M, Marxer C, Rüegg S, et al. Use of valproate in pregnancy and in women of childbearing age between 2014 and 2018 in Switzerland: a retrospective analysis of Swiss healthcare claims data. Swiss Med Wkly. 2021 Jan;151(102):w20386. 10.4414/smw.2021.20386 DOI: https://doi.org/10.4414/smw.2021.20386
  8. MacDonald SC, Cohen JM, Panchaud A, McElrath TF, Huybrechts KF, Hernández-Díaz S. Identifying pregnancies in insurance claims data: methods and application to retinoid teratogenic surveillance. Pharmacoepidemiol Drug Saf. 2019 Sep;28(9):1211–21. 10.1002/pds.4794 DOI: https://doi.org/10.1002/pds.4794
  9. Margulis AV, Setoguchi S, Mittleman MA, Glynn RJ, Dormuth CR, Hernández-Díaz S. Algorithms to estimate the beginning of pregnancy in administrative databases. Pharmacoepidemiol Drug Saf. 2013 Jan;22(1):16–24. 10.1002/pds.3284 DOI: https://doi.org/10.1002/pds.3284
  10. WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index. https://www.whocc.no/atc_ddd_index/
  11. Van Rossum G, Drake FL. Python 3 Reference Manual. Scotts Valley (CA): CreateSpace; 2009.ISBN: 978-1-4414-1269-0.
  12. Federal Statistical Office. Births. https://www.bfs.admin.ch/bfs/en/home/statistics/population/births-deaths/births.html
  13. Federal Statistical Office. Anzahl Todesfälle und Rate der perinatalen, Säuglings- und Kindersterblichkeit. https://www.bfs.admin.ch/bfs/en/home/statistics/health/state-health/mortality-causes-death/infant-stillbirths.assetdetail.23329947.html
  14. Federal Statistical Office. Durchschnittsalter von Müttern und Vätern bei Geburt des Kindes nach Staatsangehörigkeitskategorie, 1971-2021. https://www.bfs.admin.ch/bfs/de/home/statistiken/bevoelkerung/geburten-todesfaelle/fruchtbarkeit.assetdetail.23328885.html
  15. Olesen C, Thrane N, Henriksen TB, Ehrenstein V, Olsen J. Associations between socio-economic factors and the use of prescription medication during pregnancy: a population-based study among 19,874 Danish women. Eur J Clin Pharmacol. 2006 Jul;62(7):547–53. 10.1007/S00228-006-0119-X/TABLES/4 10.1007/s00228-006-0119-x DOI: https://doi.org/10.1007/s00228-006-0119-x
  16. Bornhauser C, Quack Lötscher K, Seifert B, Simões-Wüst AP. Diet, medication use and drug intake during pregnancy: data from the consecutive Swiss Health Surveys of 2007 and 2012. Swiss Med Wkly. 2017 Dec;147(51–52):w14572. 10.4414/SMW.2017.14572 10.4414/smw.2017.14572 DOI: https://doi.org/10.4414/smw.2017.14572
  17. Gerbier E, Favre G, Maisonneuve E, Ceulemans M, Winterfeld U, Dao K, et al. Antidiabetic Medication Utilisation before and during Pregnancy in Switzerland between 2012 and 2019: An Administrative Claim Database from the MAMA Cohort. J Diabetes Res. 2023 May;2023:4105993. 10.1155/2023/4105993
  18. Favre G, Gerbier E, Maisonneuve E, Pomar L, Winterfeld U, Lepigeon K, et al.; COVI-PREG and CONSIGN group. COVID-19-related medicine utilization study in pregnancy: the COVI-PREG cohort. Br J Clin Pharmacol. 2023 May;89(5):1560–74. 10.1111/BCP.15611 10.1111/bcp.15611 DOI: https://doi.org/10.1111/bcp.15611
  19. Schenkel L, Simões-Wüst AP, Hösli I, von Mandach U. Drugs in Pregnancy and Lactation - Medications Used in Swiss Obstetrics. Z Geburtshilfe Neonatol. 2018 Feb;222(4):152–64. 10.1055/S-0043-124975 10.1055/s-0043-124975 DOI: https://doi.org/10.1055/s-0043-124975
  20. Frank AS, Lupattelli A, Nordeng H. Risk factors for discontinuation of thyroid hormone replacement therapy in early pregnancy: a study from the Norwegian Mother and Child Cohort Study and the Medical Birth Registry of Norway. Acta Obstet Gynecol Scand. 2018 Jul;97(7):852–60. 10.1111/aogs.13339 DOI: https://doi.org/10.1111/aogs.13339
  21. Benevent J, Hurault-Delarue C, Araujo M, Montastruc JL, Lacroix I, Damase-Michel C. POMME: The New Cohort to Evaluate Long-Term Effects After Prenatal Medicine Exposure. Drug Saf. 2019 Jan;42(1):45–54. 10.1007/s40264-018-0712-9 DOI: https://doi.org/10.1007/s40264-018-0712-9
  22. Platt R, Brown JS, Robb M, McClellan M, Ball R, Nguyen MD, et al. The FDA Sentinel Initiative - An Evolving National Resource. N Engl J Med. 2018 Nov;379(22):2091–3. 10.1056/NEJMP1809643 10.1056/NEJMp1809643 DOI: https://doi.org/10.1056/NEJMp1809643
  23. Bérard A, Abbas-Chorfa F, Kassai B, Vial T, Nguyen KA, Sheehy O, et al. The French Pregnancy Cohort: medication use during pregnancy in the French population. PLoS One. 2019 Jul;14(7):e0219095. 10.1371/journal.pone.0219095 DOI: https://doi.org/10.1371/journal.pone.0219095
  24. Embryotox, Embryotox. www.embryotox.de
  25. Mendling W, Weissenbacher ER, Gerber S, Prasauskas V, Grob P. Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review. Arch Gynecol Obstet. 2016 Mar;293(3):469–84. 10.1007/s00404-015-3914-8 DOI: https://doi.org/10.1007/s00404-015-3914-8
  26. Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe (SGGG). Expertenbrief No. 57: Risikospezifizierung Präeklampsie im 1. Trimester; 2019.
  27. Swissmedicinfo, Swissmedicinfo: Einzelabfrage. www.swissmedicinfo.ch
  28. De Tejada BM, et al. Expertenbrief No 76, Nausea und Erbrechen in der Schwangerschaft, Hyperemesis gravidarum. Available: https://www.rosenfluh.ch/gynaekologie-2022-01/nausea-und-erbrechen-in-der-schwangerschaft-hyperemesis-gravidarum
  29. Devall AJ, Papadopoulou A, Podesek M, Haas DM, Price MJ, Coomarasamy A, et al. Progestogens for preventing miscarriage: a network meta-analysis [Review]. Cochrane Database Syst Rev. 2021 Apr;4(4):CD013792. 10.1002/14651858.CD013792.pub2 DOI: https://doi.org/10.1002/14651858.CD013792.pub2
  30. Embryotox, Fluconazol. https://www.embryotox.de/arzneimittel/details/ansicht/medikament/fluconazol
  31. Mansour O, Russo RG, Straub L, Bateman BT, Gray KJ, Huybrechts KF, et al. Prescription medication use during pregnancy in the United States from 2011 to 2020: trends and safety evidence. Am J Obstet Gynecol. 2023 Dec;(Dec):S0002-9378(23)02172-5. 10.1016/J.AJOG.2023.12.020 10.1016/j.ajog.2023.12.020
  32. Gerbier E, Graber SM, Rauch M, Marxer CA, Meier CR, Baud D, et al. Use of drugs to treat symptoms and acute conditions during pregnancy in outpatient care in Switzerland between 2014 and 2018: analysis of Swiss healthcare claims data [Internet]. Swiss Med Wkly. 2021 Nov;151(4748):w30048. [cited 2024 May 18] Available from: https://smw.ch/index.php/smw/article/view/3108 10.4414/SMW.2021.w30048 DOI: https://doi.org/10.4414/SMW.2021.w30048
  33. Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe (SGGG). Empfehlungen zur Anti-D Immunglobulin Gabe in der Schwangerschaft (=Anti-D-Prophylaxe), Expertenbrief No. 68. https://www.sggg.ch/fileadmin/user_upload/PDF/68_Empfehlungen_zur_Anti-D_Immunglobulin_Gabe_in_der_Schwangerschaft__Anti-D-Prophylaxe_.pdf
  34. Zielinski R, Searing K, Deibel M. Gastrointestinal distress in pregnancy: prevalence, assessment, and treatment of 5 common minor discomforts. J Perinat Neonatal Nurs. 2015;29(1):23–31. 10.1097/JPN.0000000000000078 DOI: https://doi.org/10.1097/JPN.0000000000000078
  35. Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe (SGGG). Debistage du diabete gestationnel, Avis d’expert No 37. https://www.sggg.ch/fileadmin/user_upload/Dokumente/3_Fachinformationen/1_Expertenbriefe/Fr/37_Depistage_du_diabete_gestationnel_2011.pdf
  36. Gerbier E, Favre G, Maisonneuve E, Ceulemans M, Winterfeld U, Dao K, et al. Antidiabetic Medication Utilisation before and during Pregnancy in Switzerland between 2012 and 2019: An Administrative Claim Database from the MAMA Cohort. J Diabetes Res. 2023 May;2023:4105993. 10.1155/2023/4105993 DOI: https://doi.org/10.1155/2023/4105993
  37. DGGG and OEGGG and SGGG, Hypertensive Schwangerschaftserkrankungen: Diagnostik und Therapie, 2019. https://register.awmf.org/de/leitlinien/detail/015-018
  38. Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe (SGGG). La tocolyse dans les menaces d’accouchement prématuré. https://www.sggg.ch/fileadmin/user_upload/PDF/41_Tocolyse_2013.pdf
  39. Federal Office of Public Health (FOPH). Health insurance: Maternity services. https://www.bag.admin.ch/bag/en/home/versicherungen/krankenversicherung/krankenversicherung-leistungen-tarife/Leistungen-bei-Mutterschaft.html
  40. De Wit ML, Rajulton F. Education and timing of parenthood among Canadian women: a cohort analysis. Soc Biol. 1992;39(1-2):109–22. 10.1080/19485565.1992.9988808 DOI: https://doi.org/10.1080/19485565.1992.9988808
  41. D. Grandt, V. Lappe, and I. Schubert, BARMER Arzneimittelreport 2021. 2021.

Most read articles by the same author(s)

1 2 3 > >>