Medication use during pregnancy and lactation in a Dutch population

M. de Waard, B.S. Blomjous, M.L.F. Hol, S.D. Sie, W.E. Corpeleijn, J.B. van Goudoever, M.M. van Weissenbruch

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Background: Medication use during pregnancy and lactation can be unavoidable, but knowledge on safety for the fetus or breastfed infant is limited among patients and healthcare providers.
Research aim: This study aimed to determine (a) the prevalence of medication use in pregnant and lactating women in a tertiary academic center, (b) the types and safety of these medicines, and (c) the influence of medication use on initiation of breastfeeding.
Methods: This study used a cross-sectional survey among women (N = 292) who underwent high-risk or low-risk deliveries. Data about their use of prescribed, over-the-counter, and homeopathic medication during pregnancy were obtained through a structured interview, followed by a questionnaire during lactation. Safety was classified according to the risk classification system from the Dutch Teratological Information Service.
Results: Overall, 95.5% of participants used medication. One third of participants used at least one medicine with an unknown risk for the fetus. Teratogenic medication was used by 6.5% of participants, whereas 29.5% used medication with a (suspected) pharmacological effect on the fetus. Lactation was initiated by 258 (88.7%) participants, of which 84.2% used medication while breastfeeding. In 3.8% of participants, this medication was classified unsafe, but none used medication with an unknown risk. One-third of the nonlactating participants decided not to initiate breastfeeding because of medication use. In 70% of participants, this decision was appropriate.
Conclusion: The prevalence of overall use of medication in Dutch pregnant and lactating women admitted to a tertiary center was high. There is an urgent need for pharmacometric studies for determination of the safe use of the most frequently used medicines during pregnancy or lactation.
Original languageEnglish
Pages (from-to)154-164
JournalJournal of Human Lactation
Volume35
Issue number1
DOIs
Publication statusPublished - Feb 2019

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: One author has received grant support and/or travel reimbursements and/or lecture/consultancy fees from Nutricia/Danone, Nestlé Nutrition Institute, Hipp, United Pharmaceuticals, Mead Johnson Nutrition, and Baxter. All prescribed and OTC medicines were classified according to the Anatomical Therapeutic Chemical classification system of the World Health Organization (2011). Safety of prescribed and OTC medicines was classified according to the risk classification system from the Teratological Information Service (Lareb, 2014). This system is consulted frequently by Dutch physicians and is available online and by phone. The service is run by an independent institute (Lareb) funded by the Ministry of Health, Welfare and Sports, which monitors the safety of medicines and vaccines in the Netherlands. Lareb works closely with similar organizations in more than 100 countries worldwide and has officially been appointed as the WHO Collaborating Centre for Pharmacovigilance in Education and Patient Reporting. They advise on medication use during pregnancy or lactation. For pregnancy, medicines are grouped into six classes and for lactation into five (see Table 1).

FundersFunder number
Baxter International
Nestlé Nutrition Institute
Ministerie van Volksgezondheid, Welzijn en Sport

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