Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia.
Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, Australia.
Drug Alcohol Rev. 2020 Mar;39(3):223-231. doi: 10.1111/dar.13033. Epub 2020 Jan 26.
Few smokers use smoking cessation pharmacotherapies during pregnancy. It is hypothesised that health-care providers' reluctance due to safety concerns contributes to their low use. This study examined the extent of providers' concern regarding smoking cessation pharmacotherapies, relative to other medications in the same and other pregnancy risk categories. Calls made to a teratology information service (MotherSafe, Australia) were taken as a proxy indicator of concern regarding safety during pregnancy.
The primary exposure discussed in 66 687 calls made to MotherSafe between 2001 and 2016 was categorised as nicotine replacement therapy (NRT), bupropion, varenicline or category A (low risk), B1, B2, B3, C, D or X (teratogenic). Separate logistic regression models estimated the odds that calls regarding pharmacotherapies were from providers, relative to medications in the same and other risk categories. Models adjusted for caller remoteness and socio-economic status.
Calls regarding bupropion were more likely to be made by providers than calls regarding other medications in its corresponding risk category [B2, adjusted odds ratio (aOR): 2.77, 95% confidence interval (CI) 1.17, 6.59]. Calls about varenicline were also more likely to be from providers than calls regarding other category B3 medications (aOR 95% CI 2.33:1.30, 4.17). Calls regarding NRT were not more or less likely to be from providers than calls regarding other category D medications.
Providers were more concerned about bupropion and varenicline than other medications within the same pregnancy risk categories. As this overestimation of risk may limit cessation pharmacotherapy use during pregnancy, research investigating strategies for correcting this imbalance is warranted.
很少有吸烟者在怀孕期间使用戒烟药物治疗。据推测，由于担心安全性，医疗保健提供者的不情愿导致了它们的低使用率。本研究考察了提供者对戒烟药物治疗的关注程度，相对于同一妊娠风险类别和其他妊娠风险类别的其他药物。通过拨打致畸信息服务（MotherSafe，澳大利亚）的电话数量来表示对怀孕期间安全性的关注程度。
2001 年至 2016 年间，MotherSafe 接到的 66687 个电话中，主要暴露因素被归类为尼古丁替代疗法（NRT）、安非他酮、伐尼克兰或 A 类（低风险）、B1、B2、B3、C、D 或 X（致畸）。分别使用逻辑回归模型估计了与同一风险类别和其他风险类别的药物相比，关于药物治疗的电话更有可能来自提供者的可能性。模型调整了呼叫者的偏远程度和社会经济地位。
与同一风险类别中的其他药物相比，关于安非他酮的电话更有可能来自提供者[B2，调整后的优势比（aOR）：2.77，95%置信区间（CI）1.17，6.59]。与其他 B3 类别药物相比，关于伐尼克兰的电话也更有可能来自提供者[aOR 95% CI 2.33：1.30，4.17]。关于 NRT 的电话来自提供者的可能性与关于其他 D 类别药物的电话相同或更低。
与同一妊娠风险类别的其他药物相比，提供者对安非他酮和伐尼克兰的关注更多。由于这种对风险的高估可能会限制怀孕期间戒烟药物治疗的使用，因此需要研究调查纠正这种不平衡的策略。
