What changes in prescription patterns of antiemetic medications in pregnant women in France?

Abstract

In France, few data are available on the prescription patterns of antiemetic medications in pregnant women. The purpose of this study was to describe antiemetic medication prescriptions and trends over time. Can we observe significantchanges in pregnant woman prescriptions in recent years? We conducted a drug utilization study among pregnant women using data from the EFEMERIS database, including 135574 pregnant women who had a pregnancy outcome between 2004 and 2017 in Haute-Garonne (France). During the study period, 40028 women (29.5%) received at least one antiemetic prescription during pregnancy. Metoclopramide (56.6%), domperidone (34.9%), and metopimazine (28.5%) were the most commonly prescribed antiemetics, whatever the trimester of pregnancy. Prescriptions of ondansetron only concerned 53 women (0.1%). The prevalence of women who received at least one prescription for an antiemetic decreased from 32.5% in 2010 to 21.6% in 2017. This decline mainly concerned domperidone prescriptions (from 13.1% in 2010 to 1.2% in 2017). Metoclopramide prescriptions also decreased slightly (18.3% in 2010 and 14.0% in 2017). Metopimazine prescriptions increased lowly (8.0% in 2010 and 9.0% in 2017). This study showed a decrease of antiemetic prescriptions between 2010 and 2017, linked to the sharp decrease in domperidone use from 2011, probably related to warnings about the risk of cardiovascular adverse effects following exposure to domperidone. We could not observe real switches to other antiemetic medications. No switches to ondansetron could be noted either, with only rare exposure during pregnancy, contrary to other countries, like the United States.