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      Medication use in pregnancy: a cross-sectional, multinational web-based study

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          Abstract

          Objectives

          Intercountry comparability between studies on medication use in pregnancy is difficult due to dissimilarities in study design and methodology. This study aimed to examine patterns and factors associated with medications use in pregnancy from a multinational perspective, with emphasis on type of medication utilised and indication for use.

          Design

          Cross-sectional, web-based study performed within the period from 1 October 2011 to 29 February 2012. Uniform collection of drug utilisation data was performed via an anonymous online questionnaire.

          Setting

          Multinational study in Europe (Western, Northern and Eastern), North and South America and Australia.

          Participants

          Pregnant women and new mothers with children less than 1 year of age.

          Primary and secondary outcome measures

          Prevalence of and factors associated with medication use for acute/short-term illnesses, chronic/long-term disorders and over-the-counter (OTC) medication use.

          Results

          The study population included 9459 women, of which 81.2% reported use of at least one medication (prescribed or OTC) during pregnancy. Overall, OTC medication use occurred in 66.9% of the pregnancies, whereas 68.4% and 17% of women reported use of at least one medication for treatment of acute/short-term illnesses and chronic/long-term disorders, respectively. The extent of self-reported medicated illnesses and types of medication used by indication varied across regions, especially in relation to urinary tract infections, depression or OTC nasal sprays. Women with higher age or lower educational level, housewives or women with an unplanned pregnancy were those most often reporting use of medication for chronic/long-term disorders. Immigrant women in Western (adjusted OR (aOR): 0.55, 95% CI 0.34 to 0.87) and Northern Europe (aOR: 0.50, 95% CI 0.31 to 0.83) were less likely to report use of medication for chronic/long-term disorders during pregnancy than non-immigrants.

          Conclusions

          In this study, the majority of women in Europe, North America, South America and Australia used at least one medication during pregnancy. There was a substantial inter-region variability in the types of medication used.

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          Most cited references34

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          Applied Logistic Regression

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            Web-based questionnaires: the future in epidemiology?

            The traditional epidemiologic modes of data collection, including paper-and-pencil questionnaires and interviews, have several limitations, such as decreasing response rates over the last decades and high costs in large study populations. The use of Web-based questionnaires may be an attractive alternative but is still scarce in epidemiologic research because of major concerns about selective nonresponse and reliability of the data obtained. The authors discuss advantages and disadvantages of Web-based questionnaires and current developments in this area. In addition, they focus on some practical issues and safety concerns involved in the application of Web-based questionnaires in epidemiologic research. They conclude that many problems related to the use of Web-based questionnaires have been solved or will most likely be solved in the near future and that this mode of data collection offers serious benefits. However, questionnaire design issues may have a major impact on response and completion rates and on reliability of the data. Theoretically, Web-based questionnaires could be considered an alternative or complementary mode in the range of epidemiologic methods of data collection. Practice and comparisons with the traditional survey techniques should reveal whether they can fulfill their expectations.
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              Medication use during pregnancy, with particular focus on prescription drugs: 1976-2008.

              The objective of the study was to provide information on overall medication use throughout pregnancy, with particular focus on the first trimester and specific prescription medications. The study design included the Slone Epidemiology Center Birth Defects Study, 1976-2008, and the National Birth Defects Prevention Study, 1997-2003, which together interviewed more than 30,000 women about their antenatal medication use. Over the last 3 decades, first-trimester use of prescription medication increased by more than 60%, and the use of 4 or more medications more than tripled. By 2008, approximately 50% of women reported taking at least 1 medication. Use of some specific medications markedly decreased or increased. Prescription medication use increased with maternal age and education, was highest for non-Hispanic whites, and varied by state. These data reflect the widespread and growing use of medications by pregnant women and reinforce the need to study their respective fetal risks and safety. Copyright © 2011 Mosby, Inc. All rights reserved.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2014
                15 February 2014
                : 4
                : 2
                : e004365
                Affiliations
                [1 ]School of Pharmacy, University of Oslo , Oslo, Norway
                [2 ]Department of Clinical Pharmacology, St Olav's University Hospital , Trondheim, Norway
                [3 ]Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology , Trondheim, Norway
                [4 ]School of Pharmacy, University of East Anglia , UK
                [5 ]Northwest Medical Center for Drug Safety in Pregnancy & Lactation, Northwest State Medical University n.a.I.I.Mechnikov , St Petersburg, Russia
                [6 ]Department of Public Health and Community Medicine, The Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
                [7 ]The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto , Toronto, Ontario, Canada
                [8 ]Faculty of Pharmacy, Medical University of Lublin , Lublin, Poland
                [9 ]School of Pharmaceutical Sciences, University of Geneva and Lausanne , Geneva, Switzerland
                [10 ]Finnish Medicines Agency , Kuopio, Finland
                [11 ]APHP, GH HUPS, Hop Antoine Béclère, Service Pharmacie, Clamart France and Européenne de Formation pour les Pharmaciens , Paris, France
                [12 ]Neuropediatric Unit, Children's Hospital Srebrnjak , Zagreb, Croatia
                [13 ]Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of pharmacy, University of Belgrade , Belgrade, Serbia
                [14 ]MotherSafe, Royal Hospital for Women and University of NSW , Randwick, Australia
                [15 ]Clinical Institute of Medical Genetics, University Medical Centre Ljubljana , Ljubljana, Slovenia
                [16 ]Research Unit Human Teratogens, Institute for Cell Biology, Histology and Embryology, Medical University of Graz , Graz, Austria
                [17 ]Teratology Information Service (TIS), The Netherlands Pharmacovigilance Centre Lareb , Den Bosch, The Netherlands
                [18 ]Division of Mental Health, Norwegian Institute of Public Health , Oslo, Norway
                Author notes
                [Correspondence to ] Angela Lupattelli; angela.lupattelli@ 123456farmasi.uio.no
                Article
                bmjopen-2013-004365
                10.1136/bmjopen-2013-004365
                3927801
                24534260
                f17f7b3a-9a73-49c5-93e0-90172f4a6b73
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

                History
                : 30 October 2013
                : 20 January 2014
                : 21 January 2014
                Categories
                Obstetrics and Gynaecology
                Research
                1506
                1845
                1845
                1723
                1724

                Medicine
                maternal medicine < obstetrics,public health,therapeutics
                Medicine
                maternal medicine < obstetrics, public health, therapeutics

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