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Abstract
INTRODUCTION The POMME (PrescriptiOn Médicaments Mères Enfants) cohort has been implemented for the evaluation of the long-term consequences of medicine prenatal exposure. It holds anonymous medical information as well as information on medicine and healthcare reimbursement to the children, from the first day of intra-uterine life until childhood. OBJECTIVE This article provides a description of the cohort regarding its structure and content and presents an outlook of the studies that could be performed with this new data source. METHODS Data sources include (1) the French Health Insurance Database (medicines and medical care prescriptions and reimbursements to children and mothers during pregnancy) and (2) the Mother and Child Protection Centre Database (child health certificates at birth, 9 months of age and 24 months of age). Children born in Haute-Garonne (south-west France), over a period of 1 year (from 1 July to 30 June), are registered in POMME every 5 years. The cohort began on 1 July, 2010. RESULTS To date, 8372 children have been recorded in POMME. They have reached 7 years of age now. Among them, 4249 (50.8%) are boys, 286 (3.4%) were from multiple pregnancies and 519 (6.2%) were born prematurely. They were prenatally exposed to 9.8 ± 6.1 medications. After birth, drug exposure was greatest in children aged 0-2 years. Children were mostly exposed to paracetamol, anti-infective agents and respiratory system drugs; 908 (10.8%) children presented with at least two signs of psychomotor development disorders. CONCLUSIONS POMME provides an observatory study on drug exposure and medical care use in children. This innovative cohort would make it possible to assess the risk of the long-term consequences of prenatal medicine exposure.
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Benevent J, Araujo M, Hurault-Delarue C, Montastruc JL, Sommet A, Lacroix I, Damase-Michel C. Pharmacoepidemiology in pregnancy. Therapie 2019; 74:289-300. [PMID: 30797568 DOI: 10.1016/j.therap.2018.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/12/2018] [Indexed: 02/05/2023]
Abstract
Taking a medication is usually a challenge for a pregnant woman as the beneficial drug effect on the mother has to be considered regarding its potential adverse effects, not only for her but also for her unborn child. As medication use is common in pregnant women, by chance or necessity, it gives the opportunity to evaluate the consequences of prenatal drug exposure in real life through pharmacoepidemiological studies. This paper provides an overview of data sources, study designs and data analysis methods that can be used for pregnancy medication safety studies. In the future, the implementation of responsive international networks may be the keystones of drug evaluation in pregnancy.
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Affiliation(s)
- Justine Benevent
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine de Toulouse, 31000 Toulouse, France; Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France; Inserm UMR 1027, faculté de médecine de Toulouse, 31000 Toulouse, France.
| | - Mélanie Araujo
- Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Caroline Hurault-Delarue
- Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Jean-Louis Montastruc
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine de Toulouse, 31000 Toulouse, France; Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Agnès Sommet
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine de Toulouse, 31000 Toulouse, France; Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Isabelle Lacroix
- Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Christine Damase-Michel
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine de Toulouse, 31000 Toulouse, France; Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France; Inserm UMR 1027, faculté de médecine de Toulouse, 31000 Toulouse, France
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Urato AC. Are the SSRI antidepressants safe in pregnancy? Understanding the debate. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2016; 27:93-9. [PMID: 26410012 DOI: 10.3233/jrs-150646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rates of antidepressant use during pregnancy are rising worldwide. It is, therefore, essential to determine the effects of these medications in pregnancy and on the developing fetus. OBJECTIVE To review the two main explanatory models for understanding the effects of antidepressant use during pregnancy and compare the evidence to support them. METHODS Review, synthesis, and discussion of the available literature. RESULTS The preponderance of the basic science, animal data, and human studies supports the view that the Harmful Chemical Model is the best explanatory framework for understanding the effects of the SSRI antidepressants during pregnancy. They do not appear to be helpful medications that produce better outcomes for moms and babies. They are not like using insulin in pregnant diabetics. Their profile fits more with a harmful chemical exposure. CONCLUSIONS The totality of the scientific evidence convincingly suggests that the SSRI antidepressants are chemicals that do cause fetal harm and that the FDA should strongly consider changing the FDA Category from C to D for the entire class. This move would provide appropriate warning to the public while still allowing for use in selected cases.
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Affiliation(s)
- Adam C Urato
- Tufts University School of Medicine, Maternal-Fetal Medicine Attending Physician, Tufts Medical Center, Boston, MA, USA.,MetroWest Medical Center, Framingham, MA, USA
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Mulder B, Pouwels KB, Schuiling-Veninga CCM, Bos HJ, de Vries TW, Jick SS, Hak E. Antibiotic use during pregnancy and asthma in preschool children: the influence of confounding. Clin Exp Allergy 2016; 46:1214-26. [PMID: 27159872 DOI: 10.1111/cea.12756] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 04/24/2016] [Accepted: 04/29/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND A recent study suggested that early-life intestinal microbiota may play an important role in the development of childhood asthma, indicating that antibiotics taken during early life or in late pregnancy may be associated with childhood asthma. OBJECTIVE This study aims to assess the association between prenatal antibiotic use and asthma in preschool children using data from the prescription database IADB.nl. To assess the influence of potential confounding, we conducted both a case-sibling and a case-control study and compared the results. METHODS We conducted a case-sibling study in which 1228 children with asthma were compared to 1228 siblings without asthma, using data from the prescription database IADB.nl. In addition, a case-control study was conducted. Asthma in preschool children was defined as ≥ 3 prescriptions for anti-asthma medication within a year before the fifth birthday. Conditional logistic regression was used to estimate crude and adjusted odds ratios (aORs). RESULTS In both the case-sibling and case-control analysis, the use of antibiotics in the third trimester of pregnancy was associated with an increased risk of asthma in preschool children (aOR 1.37; 95% CI 1.02-1.83 and aOR 1.40; 95% CI 1.15-1.47). Time-trend analyses showed that results were not influenced by a time trend in antibiotic exposure. A significant association between exposure to antibiotics in any trimester of pregnancy and the development of asthma in preschool children was observed in the case-control analysis only (aOR 1.46; 95% CI 1.34-1.59). CONCLUSION Antibiotic use in the third trimester of pregnancy was associated with a small increased risk of asthma in preschool children. This association was robust to time-invariant confounding or exposure time trends, further supporting the important role for early-life intestinal microbiota in the development of childhood asthma.
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Affiliation(s)
- B Mulder
- Department of PharmacoEpidemiology & PharmacoEconomics, University Centre of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - K B Pouwels
- Department of PharmacoEpidemiology & PharmacoEconomics, University Centre of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - C C M Schuiling-Veninga
- Department of PharmacoEpidemiology & PharmacoEconomics, University Centre of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - H J Bos
- Department of PharmacoEpidemiology & PharmacoEconomics, University Centre of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - T W de Vries
- Department of Pediatrics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - S S Jick
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Boston Collaborative Drug Surveillance Program, Boston, MA, USA
| | - E Hak
- Department of PharmacoEpidemiology & PharmacoEconomics, University Centre of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
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Liu X, Olsen J, Pedersen LH, Agerbo E, Yuan W, Li J. Antidepressant use during pregnancy and asthma in the offspring. Pediatrics 2015; 135:e911-7. [PMID: 25755245 DOI: 10.1542/peds.2014-4073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES It has been suggested that maternal depression during pregnancy is associated with asthma in the offspring, but the role of medical treatment of depression is not known. Our goal was to examine whether prenatal antidepressant use increases the risk of asthma in the offspring. METHODS A cohort study was performed among all live singletons born in Denmark between 1996 and 2007. Mothers who had a diagnosis of depressive disorder and/or who used antidepressants 1 year before or during the index pregnancy were identified. Using a Cox proportional hazards regression model, we estimated the hazard ratio (HR) for asthma in the offspring after antidepressant use during pregnancy. RESULTS Of the 733,685 children identified, 84,683 had a diagnosis of asthma. A total of 21,371 children were exposed to prenatal maternal depression (ie, a diagnosis of depressive disorder or use of antidepressants 1 year before or during pregnancy). Prenatal maternal depression was associated with childhood asthma (HR: 1.25 [95% confidence interval (CI): 1.20-1.30]). Overall, 8895 children were exposed to antidepressants in utero. Compared with children born to mothers with prenatal depression and no antidepressant use during pregnancy, the HR for asthma after any antidepressant use during pregnancy was 1.00 (95% CI: 0.93-1.08). HRs after use of selective serotonin reuptake inhibitors only, newer antidepressants only, and older antidepressants only were 0.95 (95% CI: 0.88-1.03), 1.11 (95% CI: 0.89-1.39), and 1.26 (95% CI: 1.02-1.55), respectively. CONCLUSIONS Antidepressant use during pregnancy generally did not increase the risk of asthma. Only use of older antidepressants was associated with an increased risk of asthma.
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Affiliation(s)
- Xiaoqin Liu
- Section for Epidemiology, Department of Public Health, Department of Epidemiology and Social Science on Reproductive Health, Shanghai Institute of Planned Parenthood Research, WHO Collaborating Center for Research in Human Reproduction, National Population & Family Planning Key Laboratory of Contraceptive Drugs and Devices, Shanghai, China; and
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
| | | | - Esben Agerbo
- National Centre for Register-Based Research, and CIRRAU-Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Wei Yuan
- Department of Epidemiology and Social Science on Reproductive Health, Shanghai Institute of Planned Parenthood Research, WHO Collaborating Center for Research in Human Reproduction, National Population & Family Planning Key Laboratory of Contraceptive Drugs and Devices, Shanghai, China; and
| | - Jiong Li
- Section for Epidemiology, Department of Public Health
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Zetstra-van der Woude PA, De Walle HEK, Hoek A, Bos HJ, Boezen HM, Koppelman GH, de Jong-van den Berg LTW, Scholtens S. Maternal high-dose folic acid during pregnancy and asthma medication in the offspring. Pharmacoepidemiol Drug Saf 2014; 23:1059-65. [PMID: 24930442 DOI: 10.1002/pds.3652] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 04/29/2014] [Accepted: 05/13/2014] [Indexed: 12/13/2022]
Abstract
PURPOSE Low-dose folic acid supplementation (0.5 mg) taken during pregnancy has been associated with an increased risk for childhood asthma. The effect of high-dose folic acid (5 mg) advised to women at risk for having a child with neural tube defect has not been assessed so far. Our aim was to investigate the effect of dispensed high-dose folic acid during pregnancy and asthma medication in the offspring. METHODS We used data from the pregnancy database IADB.nl, which contains pharmacy-dispensing data of mothers and children from community pharmacies in the Netherlands from 1994 until 2011. The dispension of asthma medication in children exposed in utero to high-dose folic acid was compared with children who were not exposed to this high dose. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated. RESULTS In 2.9% (N = 913) of the 39,602 pregnancies in the database, the mother was dispensed high-dose folic acid. Maternal high-dose folic acid was associated with an increased rate of asthma medication among children: recurrent asthma medication IRR = 1.14 (95%CI: 1.04-1.30) and recurrent inhaled corticosteroids IRR = 1.26 (95%CI: 1.07-1.47). Associations were clustered on the mother and adjusted for maternal age, maternal asthma medication, and dispension of benzodiazepines during pregnancy. CONCLUSION Almost 3% of the children were prenatally exposed to high-dose folic acid. This study suggests that supplementation of high-dose folic acid during pregnancy might increase the risk of childhood asthma.
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