Johan Reutfors1, Carolyn E Cesta2, Jacqueline M Cohen3, Brian T Bateman4, Ruth Brauer5, Kristjana Einarsdóttir6, Anders Engeland7, Kari Furu3, Mika Gissler8, Alys Havard9, Sonia Hernandez-Diaz10, Krista F Huybrechts11, Øystein Karlstad3, Maarit K Leinonen12, Jiong Li13, Kenneth K C Man14, Laura Pazzagli2, Andrea Schaffer9, Tania Schink15, Zixuan Wang5, Yongfu Yu13, Helga Zoega16, Gabriella Bröms17. 1. Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. Electronic address: johan.reutfors@ki.se. 2. Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. 3. Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway. 4. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America; Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's, Harvard Medical School, Boston, MA, United States of America. 5. Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK. 6. Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 7. Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway; Department of Global Public Health and Primary Care, University of Bergen, Norway. 8. Finnish Institute for Health and Welfare, Helsinki, Finland; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. 9. Centre for Big Data Research in Health, Faculty of Medicine, UNSW, Sydney, Australia. 10. Harvard T.H. Chan School of Public Health, Boston, MA, United States of America. 11. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America. 12. Finnish Institute for Health and Welfare, Helsinki, Finland. 13. Aarhus University, Aarhus, Denmark. 14. Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Erasmus University Medical Centre, Rotterdam, The Netherlands. 15. Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany. 16. Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Centre for Big Data Research in Health, Faculty of Medicine, UNSW, Sydney, Australia. 17. Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Internal Medicine, Danderyd Hospital, Stockholm, Sweden.
Abstract
AIM: To compare the prevalence and trends of antipsychotic drug use during pregnancy between countries across four continents. METHODS: Individually linked health data in Denmark (2000-2012), Finland (2005-2014), Iceland (2004-2017), Norway (2005-2015), Sweden (2006-2015), Germany (2006-2015), Australia (New South Wales, 2004-2012), Hong Kong (2001-2015), UK (2006-2016), and the US (Medicaid, 2000-2013, and IBM MarketScan, 2012-2015) were used. Using a uniformed approach, we estimated the prevalence of antipsychotic use as the proportion of pregnancies where a woman filled at least one antipsychotic prescription within three months before pregnancy until birth. For the Nordic countries, data were meta-analyzed to investigate maternal characteristics associated with the use of antipsychotics. RESULTS: We included 8,394,343 pregnancies. Typical antipsychotic use was highest in the UK (4.4%) whereas atypical antipsychotic use was highest in the US Medicaid (1.5%). Atypical antipsychotic use increased over time in most populations, reaching 2% in Australia (2012) and US Medicaid (2013). In most countries, prochlorperazine was the most commonly used typical antipsychotic and quetiapine the most commonly used atypical antipsychotic. Use of antipsychotics decreased across the trimesters of pregnancy in all populations except Finland. Antipsychotic use was elevated among smokers and those with parity ≥4 in the Nordic countries. CONCLUSION: Antipsychotic use during pregnancy varied considerably between populations, partly explained by varying use of the typical antipsychotic prochlorperazine, which is often used for nausea and vomiting in early pregnancy. Increasing usage of atypical antipsychotics among pregnant women reflects the pattern that was previously reported for the general population.
AIM: To compare the prevalence and trends of antipsychotic drug use during pregnancy between countries across four continents. METHODS: Individually linked health data in Denmark (2000-2012), Finland (2005-2014), Iceland (2004-2017), Norway (2005-2015), Sweden (2006-2015), Germany (2006-2015), Australia (New South Wales, 2004-2012), Hong Kong (2001-2015), UK (2006-2016), and the US (Medicaid, 2000-2013, and IBM MarketScan, 2012-2015) were used. Using a uniformed approach, we estimated the prevalence of antipsychotic use as the proportion of pregnancies where a woman filled at least one antipsychotic prescription within three months before pregnancy until birth. For the Nordic countries, data were meta-analyzed to investigate maternal characteristics associated with the use of antipsychotics. RESULTS: We included 8,394,343 pregnancies. Typical antipsychotic use was highest in the UK (4.4%) whereas atypical antipsychotic use was highest in the US Medicaid (1.5%). Atypical antipsychotic use increased over time in most populations, reaching 2% in Australia (2012) and US Medicaid (2013). In most countries, prochlorperazine was the most commonly used typical antipsychotic and quetiapine the most commonly used atypical antipsychotic. Use of antipsychotics decreased across the trimesters of pregnancy in all populations except Finland. Antipsychotic use was elevated among smokers and those with parity ≥4 in the Nordic countries. CONCLUSION: Antipsychotic use during pregnancy varied considerably between populations, partly explained by varying use of the typical antipsychotic prochlorperazine, which is often used for nausea and vomiting in early pregnancy. Increasing usage of atypical antipsychotics among pregnant women reflects the pattern that was previously reported for the general population.
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