Article Text
Abstract
Objective Diabetes in pregnancy and consequently the need for treatment with antidiabetic medication (ADM) has become increasingly prevalent. The prevalence and patterns of use of ADM in pregnancy from 2006 onward in seven different countries was assessed.
Research design and methods Data sources included individually linked data from the nationwide health registers in Denmark (2006–2016), Finland (2006–2016), Iceland (2006–2012), Norway (2006–2015), Sweden (2006–2015), state-wide administrative and claims data for New South Wales, Australia (2006–2012) and two US insurance databases: Medicaid Analytic eXtract (MAX; 2006–2012, public) and IBM MarketScan (2012–2015, private). The prevalence of ADM use was calculated as the proportion of pregnancies with at least one filled prescription of an ADM in the 90 days before pregnancy or within the three trimesters of pregnancy.
Results Prevalence of any ADM use in 5 279 231 pregnancies was 3% (n=147 999) and varied from under 2% (Denmark, Norway, and Sweden) to above 5% (Australia and US). Insulin was the most used ADM, and metformin was the most used oral hypoglycemic agent with increasing use over time in all countries. In 11.4%–62.5% of pregnancies with prepregnancy use, ADM (primarily metformin) was discontinued. When ADM treatment was initiated in late pregnancy for treatment of gestational diabetes mellitus, insulin was most often dispensed, except in the US, where glibenclamide was most often used.
Conclusions Prevalence and patterns of use of ADM classes varied between countries and over time. While insulin remained the most common ADM used in pregnancy, metformin use increased significantly over the study period.
- drug utilization
- gestational diabetes mellitus
- insulin
- oral antidiabetics
- pharmacoepidemiology
- population-based studies
- pregestational diabetes
- pregnancy
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Footnotes
Contributors Concept and design: all authors. Analysis: CEC, AnH, MKL, DT, and YY. Interpretation of data: all authors. Drafting of article: CEC, JMC, LP, and IO. Critical revision for important intellectual content: all authors. CEC takes full responsibility for the work as a whole, including the study design, access to data and the decision to submit and publish the manuscript.
Funding This study was funded by NordForsk as part of the Nordic Pregnancy Drug Safety Studies project (Project No: 83539) and the Research Council of Norway as part of the International Pregnancy Drug Safety Studies (InPreSS) (Project No: 273366) both awarded to KF at Norwegian Institute of Public Health (NIHP). Linkage of the Australian data was supported by an Australian National Health and Medical Research Council Project grant (No. 1028543). GB was supported by the Swedish Society of Medicine (InPreSS grant) and the Stockholm County Council (clinical postdoctoral appointment). HZ was funded by a Scientia Fellowship awarded by UNSW. BTB, SH-D and KFH were supported by the grant R01HD097778 from the Eunice Kennedy Shriver National Institute for Child Health & Human Development. YY’s salary is paid by unrestricted grants from the Lundbeck Foundation (R232-2016-2462 and R265-2017-4069), unrelated to this work. The study funders were not involved in the design of the study; the collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication.
Competing interests CEC, GB, HK, LP, and IO are employees at the Centre for Pharmacoepidemiology, which receives grants from several entities (pharmaceutical companies, regulatory authorities and contract research organizations) for the performance of drug safety and drug utilization studies, unrelated to this work. HLG reports fees and grants from pharmaceutical companies in her previous position at Oslo University Hospital, unrelated to this work. SH-D reports receiving research grants to her institution from Eli Lilly, GlaxoSmithKline, and the National Institutes of Health and consulting fees from Roche unrelated to this work and having served as an epidemiologist with the North America AED pregnancy registry, which is funded by multiple companies. KFH reports receiving research grants to her institution from Eli Lilly, Pfizer, GlaxoSmithKline, and Boehringer-Ingelheim, unrelated to this work. BTB reports receiving grants to his institution from Eli Lilly, GlaxoSmithKline, Pacira, Baxalta, Pfizer, and Aetion unrelated to this work and having served on an expert panel for a postpartum hemorrhage quality improvement project that was conducted by the Association of Women’s Health, Obstetric, and Neonatal Nurses and funded by a grant from Merck for Mothers. All other authors have no conflicts of interest to declare.
Patient consent for publication Not required.
Ethics approval Ethical committee/institutional review board approval has been granted for use of each registers/datasets from each participating country.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. This observational study is based on individual level data from the respective population-based health registers and healthcare utilization databases. The authors are not allowed, by law, to publicly share this data. Therefore, the authors are not able to make this data fully available to the public. However, aggregate-level data supporting the findings of the current study are available from the corresponding author upon reasonable request.