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Dispensing of Potentially Harmful Prescription Drugs in 1.8 Million Pregnant Women in France: A Nationwide Study Based on Two Risk Classification Systems
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Edité par CCSD ; Springer Verlag -
International audience. Introduction Nationwide prevalence of potentially harmful drug prescribing during pregnancy is unknown in France, andseveral risk classification systems (RCS) exist to guide prescribers.Objective The aim of this study was to estimate the nationwide prevalence of potentially harmful drug prescribing duringpregnancy in France and to describe maternal characteristics associated with this prescription.Methods This drug utilisation study, conducted on the French health databases (67 million beneficiaries), included allpregnancies beginning in 2016–2017, regardless of pregnancy outcome. Potentially harmful drug prescribing was definedas at least one reimbursement during pregnancy of Swedish RCS category D drugs, Australian RCS category D/X drugs, orcontraindicated drugs in France for drugs not listed in these two RCSs. Maternal characteristics associated with potentiallyharmful drug prescribing were described using a univariate logistic regression analysis.Results Among the 1,844,447 pregnant women identified, the prevalence of potentially harmful drug prescribing washigher according to the Australian RCS (3.9%) than according to the Swedish RCS (2.2%), with good agreement betweenthe two RCSs (Kappa = 0.81 [0.74–0.87]). This prevalence increased to 9.2% and 6.9%, respectively, when consideringcontraindications in France. Prescribing of teratogenic drugs, including retinoids and valproate, was highest during the firsttrimester, whereas prescribing of foetotoxic drugs decreased after the first trimester but remained high for nonsteroidal anti-inflammatory drugs (N = 10,021). In women with no chronic diseases, polymedication (five or more drugs) was the strongestmaternal characteristic associated with potentially harmful drug prescribing in both RCSs.Conclusions Potentially harmful drug prescribing during pregnancy is not uncommon in France. This study supports thecomparative analysis of RCS to assess potentially harmful drug prescribing in claims databases.
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