TY - JOUR
T1 - Prescribing of Antidiabetic Medicines before, during and after Pregnancy
T2 - A Study in Seven European Regions
AU - Charlton, Rachel A.
AU - Klungsoyr, Kari
AU - Neville, Amanda J.
AU - Jordan, Sue
AU - Pierini, Anna
AU - de Jong-van den Berg, Lolkje T. W.
AU - Bos, H. Jens
AU - Puccini, Aurora
AU - Engeland, Anders
AU - Gini, Rosa
AU - Davies, Gareth
AU - Thayer, Daniel
AU - Hansen, Anne V.
AU - Morgan, Margery
AU - Wang, Hao
AU - McGrogan, Anita
AU - Andersen, Anne-Marie Nybo
AU - Dolk, Helen
AU - Garne, Ester
PY - 2016/5/18
Y1 - 2016/5/18
N2 - AimTo explore antidiabetic medicine prescribing to women before, during and after pregnancy in different regions of Europe.MethodsA common protocol was implemented across seven databases in Denmark, Norway, The Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK. Women with a pregnancy starting and ending between 2004 and 2010, (Denmark, 2004-2009; Norway, 2005-2010; Emilia Romagna, 2008-2010), which ended in a live or stillbirth, were identified. Prescriptions for antidiabetic medicines issued (UK) or dispensed (non-UK) during pregnancy and/or the year before or year after pregnancy were identified. Prescribing patterns were compared across databases and over calendar time.Results1,082,673 live/stillbirths were identified. Pregestational insulin prescribing during the year before pregnancy ranged from 0.27% (CI95 0.25-0.30) in Tuscany to 0.45% (CI95 0.43-0.47) in Norway, and increased between 2004 and 2009 in all countries. During pregnancy, insulin prescribing peaked during the third trimester and increased over time; third trimester prescribing was highest in Tuscany (2.2%) and lowest in Denmark (0.5%). Of those prescribed an insulin during pregnancy, between 50.5% in Denmark and 88.8% in the Netherlands received an insulin analogue alone or in combination with human insulin, this proportion increasing over time. Oral products were mainly metformin and prescribing was highest in the 3 months before pregnancy. Metformin use during pregnancy increased in some countries.ConclusionPregestational diabetes is increasing in many areas of Europe. There is considerable variation between and within countries in the choice of medication for treating pregestational diabetes in pregnancy, including choice of insulin analogues and oral antidiabetics, and very large variation in the treatment of gestational diabetes despite international guidelines.
AB - AimTo explore antidiabetic medicine prescribing to women before, during and after pregnancy in different regions of Europe.MethodsA common protocol was implemented across seven databases in Denmark, Norway, The Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK. Women with a pregnancy starting and ending between 2004 and 2010, (Denmark, 2004-2009; Norway, 2005-2010; Emilia Romagna, 2008-2010), which ended in a live or stillbirth, were identified. Prescriptions for antidiabetic medicines issued (UK) or dispensed (non-UK) during pregnancy and/or the year before or year after pregnancy were identified. Prescribing patterns were compared across databases and over calendar time.Results1,082,673 live/stillbirths were identified. Pregestational insulin prescribing during the year before pregnancy ranged from 0.27% (CI95 0.25-0.30) in Tuscany to 0.45% (CI95 0.43-0.47) in Norway, and increased between 2004 and 2009 in all countries. During pregnancy, insulin prescribing peaked during the third trimester and increased over time; third trimester prescribing was highest in Tuscany (2.2%) and lowest in Denmark (0.5%). Of those prescribed an insulin during pregnancy, between 50.5% in Denmark and 88.8% in the Netherlands received an insulin analogue alone or in combination with human insulin, this proportion increasing over time. Oral products were mainly metformin and prescribing was highest in the 3 months before pregnancy. Metformin use during pregnancy increased in some countries.ConclusionPregestational diabetes is increasing in many areas of Europe. There is considerable variation between and within countries in the choice of medication for treating pregestational diabetes in pregnancy, including choice of insulin analogues and oral antidiabetics, and very large variation in the treatment of gestational diabetes despite international guidelines.
KW - CONGENITAL-ANOMALIES
KW - INSULIN ANALOGS
KW - WOMEN
KW - TYPE-1
KW - HEALTH
KW - CARE
KW - PREVALENCE
KW - DATABASE
KW - IADB
U2 - 10.1371/journal.pone.0155737
DO - 10.1371/journal.pone.0155737
M3 - Article
C2 - 27192491
SN - 1932-6203
VL - 11
JO - PLoS ONE
JF - PLoS ONE
IS - 5
M1 - e0155737
ER -