(P-475) Use of prescribed drugs to treat frequent conditions during pregnancy in outpatient care in Switzerland: Analysis of Swiss health care claims data

Location: Poster Gallery-Drug Utilization Research

Presenting Author(s)

EG

Eva v. Gerbier

Centre Hospitalier Universitaire Vaudois
La sarraz, Vaud, Switzerland

Co-Author(s)

SG

Sereina M. Graber, PhD

Department of Health Sciences, Helsana Insurance Group, Zurich, Switzerland, Switzerland
MR

Marlene Rauch, PhD, n/a

Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland, Switzerland
CM

Carole A. Marxer, MSc

Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland, Switzerland
CM

Christoph R. Meier, PhD, MSc

Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Switzerland, Switzerland
DB

David Baud

Materno-Fetal and Obstetrics Research Unit, Department “Woman-Mother-Child”, Lausanne University Hospital, Lausanne, Switzerland, Switzerland
UW

Ursula Winterfeld

Swiss Teratogen Information Service and Clinical Pharmacology Service, CHUV, Lausanne, Switzerland, Switzerland
EB

Eva Blozik, MD, MPH

Department of Health Sciences, Helsana Insurance Group, Zurich, Switzerland, Switzerland
DS

Daniel Surbek

Department of Obstetrics and Gynaecology, University Hospital, University of Bern, Switzerland, Switzerland
JS

Julia Spoendlin, PhD, MPH

Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland, Switzerland
AP

Alice Panchaud, PhD

Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Switzerland, Switzerland

Background: Representative evidence on the use of drugs during pregnancy in Switzerland is lacking.

Objectives: To evaluate the utilization of prescribed drugs during pregnancy in outpatient care in Switzerland, focusing on treatments for pain, infections, gastroesophageal reflux, and nausea/vomiting.

Methods: We conducted a descriptive study using the claims database by the Swiss health insurance Helsana (2014-2018). In a previously established cohort of pregnancies (leading to delivery), we identified claims for the following drugs between the estimated date of the last menstrual period and delivery; analgesics (opioids, paracetamol, and NSAIDs), oral antibiotics, antacids, proton pump inhibitors (PPI), and anti-nausea drugs (propulsives and 5HT3-antagonists; antihistamines are not reimbursed). We further captured claims for potentially teratogenic or fetotoxic drugs (based on the French information website “Le CRAT”); NSAID after week 24, trimethoprim/sulfonamide, and quinolone in trimester 1, and tetracyclines in trimester 2 and 3. Results were extrapolated relative to the demographic distribution of the Swiss population.

Results: We identified an extrapolated population of 369’371 pregnancies, with a mean maternal age of 32.02 (standard deviation [SD] 0.01) years. Analgesics were claimed in 31.7% (95% confidence intervals [CI] 31.2%-32.2%) of pregnancies, most frequently paracetamol (30.3%, 29.8%-30.8%), followed by NSAIDs (8.6%, 8.3%-8.8%), and opioids (2.6%, 2.4%-2.8%). NSAIDs were claimed in 1.3% (1.2%-1.4%) of pregnancies after week 24. Antibiotics were dispensed in 26.3% (25.8%-26.8%) of pregnancies, most frequently amoxicilline (12.4%, 95% CI 12.0%-12.7%). Claims for potentially teratogenic antibiotics during risk periods were each recorded in <0.6% of pregnancies.
PPIs were claimed in 16.0% (15.6%-16.3%) and antacids in 10.6% (10.3%-11.0%) of pregnancies, but several antacid products are not reimbursed. Anti-nausea drugs were claimed in 16.4% (16.0%-16.7%) of pregnancies (13% 12.7%-13.4% in trimester 1), most frequently metoclopramide in 14.4% (14.0%-14.7%) followed by ondansetron in 1.3% (1.2%-1.4%) [mainly dispensed in trimester 1 (1%,0.9%-1.1%)].

Conclusions: The observed pattern of claimed drugs during pregnancy is in line with existing treatment guidelines. Exposure to potentially teratogenic or fetotoxic drugs was small, but given the lack of recorded diagnosis, we cannot determine if their use was clinically indicated. Our study demonstrates that Swiss health care claims databases are a valuable tool to evaluate drug utilization during pregnancy in Switzerland.