College of Medicine and Public Health, Flinders University, Adelaide, SA.
South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA.
Med J Aust. 2024 Oct 7;221(7):367-373. doi: 10.5694/mja2.52451. Epub 2024 Sep 16.
To examine patterns in the dispensing of category X medications (Therapeutic Goods Administration categorisation system for prescribing medicines in pregnancy) to women aged 15-49 years in Australia during 2008-2021, and patterns of concurrent use of hormonal long-acting reversible contraception (LARC) and other hormonal contraception.
Retrospective cohort study; analysis of 10% random sample of national Pharmaceutical Benefits Scheme dispensing data.
PARTICIPANTS, SETTING: Women aged 15-49 years dispensed category X medications, Australia, 1 January 2013 - 31 December 2021.
Incident and prevalent dispensing of category X medications, by medication class, age group, and year; contraceptive overlap (proportions of women dispensed hormonal LARC or other hormonal contraception that overlapped the first dispensing of category X medications), by medication class.
Among 15 627 women aged 15-49 years dispensed category X medications during 2013-2021, the prevalence of dispensing increased from 4.6 in 2013 to 8.7 per 1000 women aged 15-49 years in 2021; the largest increase was for the dispensing of dermatological agents, from 3.9 to 7.9 per 1000 women aged 15-49 years. LARC overlap was inferred for 2059 women at the time of first dispensing of category X medications (13.2%); 3441 had been dispensed any type of hormonal contraception (22.1%). The proportion with LARC overlap was smallest for those dispensed dermatological agents (1806 of 14 331 women, 12.6%); for this drug class, both LARC overlap (adjusted odds ratio [aOR], 0.17; 95% confidence interval [CI], 0.14-0.20) and any hormonal contraception overlap (aOR, 0.28; 95% CI, 0.25-0.32) were less likely for those aged 15-19 years than for women aged 25-29 years.
Concurrent use of highly effective hormonal contraception at the time of first dispensing of category X medications is low in Australia, raising concerns about potential fetal harms during unintended pregnancies. Awareness of the importance of hormonal contraception and its uptake by women prescribed category X medications should be increased.
研究 2008-2021 年期间澳大利亚 15-49 岁女性中 X 类药物（治疗用品管理局规定的妊娠药物处方分类系统）的配药模式，以及同时使用激素长效可逆避孕（LARC）和其他激素避孕的模式。
回顾性队列研究；对国家药品福利计划配药数据的 10%随机样本进行分析。
参与者、地点：2013 年 1 月 1 日至 2021 年 12 月 31 日期间，15-49 岁年龄组的澳大利亚 X 类药物配药女性。
按药物类别、年龄组和年份划分的 X 类药物的新发和现患配药情况；避孕重叠（首次配药 X 类药物时，同时配给激素 LARC 或其他激素避孕的女性比例），按药物类别划分。
在 2013-2021 年期间，15-49 岁年龄组的 15627 名女性中，X 类药物的配药率从 2013 年的 4.6 上升到 2021 年的每 1000 名 15-49 岁女性 8.7 例；最大的增长是皮肤科药物，从每 1000 名 15-49 岁女性 3.9 例上升到 7.9 例。在首次配药 X 类药物时，有 2059 名女性推断出 LARC 重叠（13.2%）；3441 名女性曾配给过任何类型的激素避孕（22.1%）。LARC 重叠比例最小的是配给皮肤科药物的女性（14331 名女性中的 1806 名，占 12.6%）；对于这种药物类别，LARC 重叠（调整后的优势比[aOR]，0.17；95%置信区间[CI]，0.14-0.20）和任何激素避孕重叠（aOR，0.28；95%CI，0.25-0.32）在 15-19 岁年龄组的可能性均低于 25-29 岁年龄组。
在澳大利亚，首次配药 X 类药物时同时使用高效激素避孕的情况很少，这让人对意外怀孕期间胎儿潜在危害感到担忧。应提高女性对 X 类药物处方中激素避孕重要性的认识及其使用率。
