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. 2022 Dec 1;17(12):e0277623.
doi: 10.1371/journal.pone.0277623. eCollection 2022.

Patterns of antiemetic medication use during pregnancy: A multi-country retrospective cohort study

Anat Fisher  1 , J Michael Paterson  2   3 , Brandace Winquist  4   5 , Fangyun Wu  2 , Pauline Reynier  6 , Samy Suissa  7 , Matthew Dahl  8 , Zhihai Ma  9 , Xinya Lu  5 , Jianguo Zhang  9 , Colette B Raymond  8 , Kristian B Filion  6   7   10 , Robert W Platt  6   7   11 , Carolina Moriello  6 , Colin R Dormuth  1 ; Canadian Network for Observational Drug Effect Studies (CNODES) Investigators
Affiliations

Patterns of antiemetic medication use during pregnancy: A multi-country retrospective cohort study

Anat Fisher et al. PLoS One. .

Abstract

Objective: To compare patterns in use of different antiemetics during pregnancy in Canada, the United Kingdom, and the United States, between 2002 and 2014.

Methods: We constructed population-based cohorts of pregnant women using administrative healthcare data from five Canadian provinces (Alberta, British Columbia, Manitoba, Ontario, and Saskatchewan), the Clinical Practice Research Datalink from the United Kingdom, and the IBM MarketScan Research Databases from the United States. We included pregnancies ending in live births, stillbirth, spontaneous abortion, or induced abortion. We determined maternal use of antiemetics from pharmacy claims in Canada and the United States and from prescriptions in the United Kingdom.

Results: The most common outcome of 3 848 734 included pregnancies (started 2002-2014) was live birth (66.7% of all pregnancies) followed by spontaneous abortion (20.2%). Use of antiemetics during pregnancy increased over time in all three countries. Canada had the highest prevalence of use of prescription antiemetics during pregnancy (17.7% of pregnancies overall, 13.2% of pregnancies in 2002, and 18.9% in 2014), followed by the United States (14.0% overall, 8.9% in 2007, and 18.1% in 2014), and the United Kingdom (5.0% overall, 4.2% in 2002, and 6.5% in 2014). Besides use of antiemetic drugs being considerably lower in the United Kingdom, the increase in its use over time was more modest. The most commonly used antiemetic was combination doxylamine/pyridoxine in Canada (95.2% of pregnancies treated with antiemetics), ondansetron in the United States (72.2%), and prochlorperazine in the United Kingdom (63.5%).

Conclusions: In this large cohort study, we observed an overall increase in antiemetic use during pregnancy, and patterns of use varied across jurisdictions. Continued monitoring of antiemetic use and further research are warranted to better understand the reasons for differences in use of these medications and to assess their benefit-risk profile in this population.

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Conflict of interest statement

: SS reported receiving personal fees from Atara, AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Novartis, Pfizer, and Seqirus outside the submitted work. KBF is supported by a salary support award from the Fonds de recherche du Québec – santé (FRQS; Quebec Foundation for Research – Health) and a William Dawson Scholar award from McGill University. RWP holds the Albert Boehringer I Chair in Pharmacoepidemiology at McGill University. RWP reported receiving personal fees from Amgen, Biogen, Merck, and Pfizer outside the submitted work. MP reported grants from Canadian Institutes of Health Research during the conduct of the study. No other disclosures were reported. No endorsement by the funders, data providers, data stewards, CIHI, or Health Canada is intended or should be inferred. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Use of antiemetic medications in Canada, the United Kingdom, and the United States between 2002 and 2014, by year of pregnancy onset.
(A) in the 90 days before pregnancy onset; (B) during the first trimester of pregnancy; (C) anytime during pregnancy. Pregnancy onset was defined as the first day of the last menstrual period.
Fig 2
Fig 2. Use of antiemetic medications during pregnancy in Canada by province and year of pregnancy onset, 2002–2014.
Pregnancy onset was defined as the first day of the last menstrual period.
See this image and copyright information in PMC

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