Egen-Lappe Veronika, Hasford Joerg
Institute for Medical Informatics, Biometry and Epidemiology (IBE), University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
Eur J Clin Pharmacol. 2004 Nov;60(9):659-66. doi: 10.1007/s00228-004-0817-1. Epub 2004 Oct 7.
To examine the prescription of drugs in Germany prior to, during and after pregnancy.
For the first time, prescription data of a large cohort of pregnant women, from a German statutory sickness fund, were available for scientific analysis. For each woman who gave birth between June 2000 and May 2001 reimbursed prescriptions for two periods (90 days each) before pregnancy, three during and two after delivery were considered. The drugs were classified according to the ATC code.
Of the 41,293 women, 96.4% received at least one drug during pregnancy. A median of 7 drugs per women was prescribed. Excluding vitamins, minerals, iodide and iron, 85.2% received at least one drug and the median was 3. Magnesium, which was seldom prescribed outside of pregnancy, was by far the most frequently prescribed substance (20% of all prescriptions, 61% of the women). Iron (54% of the women) and iodide (31%) were also prescribed often. The prescription rates of gynaecological antiinfectives (maximum in third trimester: 23% of the women), antacids (max. in third trim.: 11%), as well as antiemetics and antinauseants (max. in first trim.: 8%) during pregnancy considerably increased. A decrease was seen for analgesics, antiinflammatory and antirheumatic drugs, muscle relaxants, ophtalmologicals and anti-acne preparations, for example. Potential teratogenic drugs were prescribed to 1.3% of the women.
This analysis of a large nation-wide cohort of pregnant women showed that during pregnancy drugs were prescribed to most women, even when vitamins, minerals, iodide and iron were omitted. Magnesium and iron seemed to have been over-prescribed. On the other hand, the official recommendation for iodide substitution, to prevent thyroid diseases in mother and child, was insufficiently implemented. In our opinion, regular analysis of prescription data can identify potential harmful therapies and focal points where guidelines are needed and can check their implementation.
研究德国孕妇怀孕前、孕期及产后的用药情况。
首次获得了来自德国法定疾病基金的一大群孕妇的处方数据，可用于科学分析。对于2000年6月至2001年5月期间分娩的每位女性，考虑其怀孕前两个时期（各90天）、孕期三个时期及产后两个时期的报销处方。药物根据解剖学治疗学及化学分类代码进行分类。
在41293名女性中，96.4%在孕期至少服用过一种药物。每位女性平均开具了7种药物。排除维生素、矿物质、碘化物和铁剂后，85.2%的女性至少服用过一种药物，平均为3种。镁在非孕期很少开具，是目前开具最频繁的药物（占所有处方的20%，61%的女性使用）。铁剂（54%的女性使用）和碘化物（31%）也经常开具。孕期妇科抗感染药（孕晚期最高：23%的女性使用）、抗酸剂（孕晚期最高：11%）以及止吐药和抗恶心药（孕早期最高：8%）的处方率显著增加。例如，镇痛药、抗炎和抗风湿药、肌肉松弛剂、眼科用药和抗痤疮制剂的处方率有所下降。1.3%的女性使用了潜在致畸药物。
对一大群全国范围的孕妇进行的这项分析表明，即使排除维生素、矿物质、碘化物和铁剂，大多数女性在孕期仍会用药。镁和铁似乎存在过度开具的情况。另一方面，预防母婴甲状腺疾病的碘替代官方建议未得到充分落实。我们认为，定期分析处方数据可以识别潜在有害治疗方法和需要制定指南的重点领域，并检查其实施情况。
