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. 2017 Dec 28;12(12):e0190101.
doi: 10.1371/journal.pone.0190101. eCollection 2017.

Complex patterns of concomitant medication use: A study among Norwegian women using paracetamol during pregnancy

Stefania Salvatore  1   2 , Diana Domanska  1 , Mollie Wood  2   3 , Hedvig Nordeng  2   3   4 , Geir Kjetil Sandve  1   4
Affiliations

Complex patterns of concomitant medication use: A study among Norwegian women using paracetamol during pregnancy

Stefania Salvatore et al. PLoS One. .

Abstract

Background: Studies on medication safety in pregnancy often rely on an oversimplification of medication use into exposed or non-exposed, without considering intensity and timing of use in pregnancy, or concomitant medication use. This study uses paracetamol in pregnancy as the motivating example to introduce a method of clustering medication exposures longitudinally throughout pregnancy. The aim of this study was to use hierarchical cluster analysis (HCA) to better identify clusters of medication exposure throughout pregnancy.

Methods: Data from the Norwegian Mother and Child Cohort Study was used to identify subclasses of women using paracetamol during pregnancy. HCA with customized distance measure was used to identify clusters of medication exposures in pregnancy among children at 18 months.

Results: The pregnancies in the study (N = 9 778) were grouped in 5 different clusters depending on their medication exposure profile throughout pregnancy.

Conclusion: Using HCA, we identified and described profiles of women exposed to different medications in combination with paracetamol during pregnancy. Identifying these clusters allows researchers to define exposure in ways that better reflects real-world medication usage patterns. This method could be extended to other medications and used as pre-analysis for identifying risks associated with different profiles of exposure.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of inclusion for the final study population.
Fig 2
Fig 2. Dendrogram and heatmap of clustering results.
The x-axis of the dendrogram indicates mothers exposed to paracetamol in pregnancy, while the y-axis of the dendrogram indicates at which height mothers are clustered together. The colors of the heatmap indicate the values of pairwise distance between mothers exposed to paracetamol in pregnancy. The distance values go from 0 (indicating no distance in blue) to 60 (indicating maximum distance in yellow color).
Fig 3
Fig 3. Maternal and child characteristics of exposure to different medication groups by clusters.
See this image and copyright information in PMC

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