Hurault Caroline, Lacroix Isabelle, Bourrel Robert, Montastruc Jean-Louis, Damase-Michel Christine
Service de pharmacologie clinique, Unité Médicaments, grossesse et allaitement, Centre Hospitalier Universitaire, EA 3696 Université de Toulouse, F-31000 Toulouse, France.
Presse Med. 2008 May;37(5 Pt 1):767-74. doi: 10.1016/j.lpm.2007.07.027. Epub 2008 Jan 15.
To evaluate the impact a year afterwards of a letter sent by French health authorities (AFSSAPS) to health care professionals on 12 December 2003 to remind them that late pregnancy is a contraindication to nonsteroidal antiinflammatory drugs (NSAIDs).
We used records of the general health insurance fund in the district of Haute-Garonne to study the dispensing of prescription NSAIDS during late pregnancy to women who gave birth in this district both before the letter was sent (n=3099) (before group) and afterwards (2751 women who delivered between 12 July and 12 October 2004: "early after" group) and 2859 women between 12 March and 12 June 2005: "late after" group). We performed a "before-and-after" comparison.
In the before group, 6.6% of the pregnant women had at least one NSAID prescription written and dispensed after the beginning of the sixth month of pregnancy, while this was the case for 5.1% of the women in the "early after" group (p=0.03) and 4.4% of the women in the "late after" group (p=0.004). Moreover, prescriptions and dispensing of paracetamol increased significantly (from 26.8% of the exposed women in 2003 to 36.6% in 2005, p<0.0001).
The "before-and-after" comparison does not allow us to be sure of the causal link between the recommendations and the changes observed in the writing and dispensing of NSAID prescriptions. Nevertheless, we can hypothesize that this letter contributed to the decrease observed. The reduction is encouraging, but remains insufficient: in 2005, 4.4% of pregnant women were still receiving and filling prescriptions that are potentially harmful to fetuses and neonates.
评估2003年12月12日法国卫生当局（AFSSAPS）致医护人员的一封信件在一年后的影响，该信件提醒他们晚期妊娠是使用非甾体抗炎药（NSAIDs）的禁忌证。
我们利用上加龙省地区基本医疗保险基金的记录，研究在该信件发出之前（n = 3099）（前组）以及之后在该地区分娩的晚期妊娠妇女中处方NSAIDs的配药情况，之后的妇女分为两组，2004年7月12日至10月12日分娩的2751名妇女（“早期后”组）和2005年3月12日至6月12日分娩的2859名妇女（“晚期后”组）。我们进行了“前后”比较。
在前组中，6.6%的孕妇在妊娠第六个月开始后至少有一张NSAIDs处方开具并配药，而“早期后”组中这一比例为5.1%（p = 0.03），“晚期后”组中这一比例为4.4%（p = 0.004）。此外，对乙酰氨基酚的处方和配药显著增加（从2003年暴露妇女中的26.8%增至2005年的36.6%，p < 0.0001）。
“前后”比较无法让我们确定这些建议与NSAIDs处方开具和配药中观察到的变化之间的因果关系。然而，我们可以推测这封信促成了观察到的减少。这种减少令人鼓舞，但仍不充分：2005年，仍有4.4%的孕妇在接受并填写可能对胎儿和新生儿有害的处方。
