Abstract
To describe drug prescription for gastrointestinal symptoms during pregnancy. Using the French national health database, we identified pregnancies ending with a birth between April 2010 and December 2018, in France. We studied prescription of antacids, antispasmodics, antinauseants, laxatives and antidiarrheals during pregnancy, between two trimesters before and two trimesters after delivery. We also assessed hospitalization for gastrointestinal symptoms during pregnancy. Among 6,365,471 pregnancies, 4,452,779 (74.0%) received at least one gastrointestinal drug during pregnancy; 2,228,275 (37.0%) received an antacid, 3,096,858 (51.5%) an antispasmodic, 1,861,731 (31.0%) an antinauseant, 919,116 (15.3%) a laxative and 617,808 (10.3%) an antidiarrheal. Prescription of proton pump inhibitors doubled from 12.2% in 2010 to 26.0% in 2018, while domperidone use decreased from 18.3% in 2010 to 2.2% in 2018. In addition, prescription of antacids increased from 7.0% during the trimester before pregnancy to 11.8% during the 1st trimester, 17.0% during the 2nd trimester and 23.4% during the 3rd trimester. Antispasmodic use was 10.6% during the trimester before pregnancy, 23.1% during the 1st trimester, 25.2% during the 2nd trimester and 24.0% during the 3rd trimester. Prescription of antinauseant drugs increased from 5.0% during the trimester before pregnancy to 25.7% during the 1st trimester, then decreased to 6.4% during the 2nd trimester and 3.2% during the 3rd trimester. Nausea/vomiting was the most common cause of hospitalization for gastrointestinal symptoms or diseases during pregnancy, although it accounted for only 1.0% of pregnancies. Approximately three-quarters of women use drugs for gastrointestinal symptoms during pregnancy in France. Prescription of gastrointestinal drugs during pregnancy should be the subject of more detailed risk-benefit assessment and recommendations.
Highlights
Background and aimsThalidomide was used as an antinauseant medication during pregnancy until its teratogenic effect was demonstrated in the 1960s
Nausea/vomiting was the most common cause of hospitalization for gastrointestinal symptoms or diseases during pregnancy, it accounted for only 1.0% of pregnancies
We studied each drug dispensed for gastrointestinal symptoms including: antacids, antispasmodics, antinauseants, laxatives, antidiarrheals and other drugs for functional gastrointestinal disorders
Summary
Thalidomide was used as an antinauseant medication during pregnancy until its teratogenic effect was demonstrated in the 1960s. This scandal led to an increased awareness of the safe use of drugs during pregnancy [1]. Data on the safety of drugs used during pregnancy (for women and offspring) is often lacking as pre-marketing clinical trials exclude pregnant women. Observational studies are essential to study the efficacy and safety drugs in pregnant women and their offspring. Between 58% and 97% of women take at least one medication during pregnancy, depending on the country [4,5,6,7]. Drug use studies in pregnancy are useful to identify the most frequently used drugs and thereby decide which drug safety studies should be prioritized
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