Medication use in pregnancy: a cross-sectional, multinational web-based study.

OBJECTIVES: Intercountry comparability between studies on medication use in pregnancy is difficult due to dissimilarities in study design and methodology. This study aimed to examine patterns and factors associated with medications use in pregnancy from a multinational perspective, with emphasis on type of medication utilised and indication for use. DESIGN: Cross-sectional, web-based study performed within the period from 1 October 2011 to 29 February 2012. Uniform collection of drug utilisation data was performed via an anonymous online questionnaire. SETTING: Multinational study in Europe (Western, Northern and Eastern), North and South America and Australia. PARTICIPANTS: Pregnant women and new mothers with children less than 1 year of age. PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence of and factors associated with medication use for acute/short-term illnesses, chronic/long-term disorders and over-the-counter (OTC) medication use. RESULTS: The study population included 9459 women, of which 81.2% reported use of at least one medication (prescribed or OTC) during pregnancy. Overall, OTC medication use occurred in 66.9% of the pregnancies, whereas 68.4% and 17% of women reported use of at least one medication for treatment of acute/short-term illnesses and chronic/long-term disorders, respectively. The extent of self-reported medicated illnesses and types of medication used by indication varied across regions, especially in relation to urinary tract infections, depression or OTC nasal sprays. Women with higher age or lower educational level, housewives or women with an unplanned pregnancy were those most often reporting use of medication for chronic/long-term disorders. Immigrant women in Western (adjusted OR (aOR): 0.55, 95% CI 0.34 to 0.87) and Northern Europe (aOR: 0.50, 95% CI 0.31 to 0.83) were less likely to report use of medication for chronic/long-term disorders during pregnancy than non-immigrants. CONCLUSIONS: In this study, the majority of women in Europe, North America, South America and Australia used at least one medication during pregnancy. There was a substantial inter-region variability in the types of medication used.

Influence of refill adherence method when comparing level of adherence for different dosing regimens.

PURPOSE: To examine the impact of two methods when estimating refill adherence in patients using bisphosphonates with different dosing regimens. METHODS: In the Swedish Prescribed Drug Register, 18,203 new users of bisphosphonates aged 18-85 years were identified between 1 July 2006 and 30 June 2007 and followed for a maximum of 2 years. The patients were categorised based on dosing regimen: one tablet daily, one tablet weekly, switching between these regimens, and other regimens. Refill adherence was estimated with Continuous measure of Medication Acquisition (CMA, adherent if CMA ≥ 80 %) and the maximum gap method (adherent if gaps <45 days). Differences in adherence between patients in the groups were assessed with logistic regression models controlling for confounding factors. RESULTS: The proportion of patients classified as adherent was higher using CMA compared with patients classified as adherent using the maximum gap method. Patients on one tablet weekly had significantly lower adherence compared with patients on one tablet daily in the main analyses of both methods (the maximum gap method: 73 % vs. 80 %; adjusted OR=0.71; 95 % CI 0.57-0.89 and CMA: 84 % vs. 88 %, adjusted OR=0.75; 95 % CI 0.57-0.99). Patients using the other two dosing regimens had significantly lower adherence compared with patients on one tablet daily using both methods. CONCLUSION: Choice of method has an impact on the estimates of refill adherence to bisphosphonates. Patients on one tablet weekly dosing had lower adherence compared with patients on one tablet daily dosing using both methods.

Harmful alcohol habits were no more common in a sample of newly sick-listed Swedish women and men compared with a random population sample.

AIMS: To estimate harmful alcohol habits in a sample of incident sick-listed individuals compared with a random sample from the general population taking social background, health and work-related factors into account. METHODS: Data for this cross-sectional questionnaire study were collected in 2008 in the Västra Götaland region, Sweden. The study population (19-64 year olds) consisted of 2888 consecutive incident sick-leave sample (ISS) and 3567 individuals from a random population sample (RPS). The mailed questionnaire included Alcohol Use Disorder Identification Test and validated instruments on health and work-related factors. Socio-demographic data came from register data. Analyses were made with χ(2) tests and logistic regression analyses. RESULTS: No differences in prevalence of harmful alcohol habits were found between men in the ISS (22%) and the RPS (21%). Compared with women in the ISS, a higher proportion of women in the RPS were likely to report harmful alcohol habits [14 versus 9% (P < 0.001)]. This difference was confirmed in the logistic regression analyses where women in the RPS had higher odds of having harmful alcohol habits compared with women in the ISS [odds ratio (OR) = 1.54 (95% confidence interval (CI): 1.23-1.89)]. Even after controlling for significant confounders (age, low income, high self-reported health and high level of perceived symptoms), we found that the differences in harmful alcohol habits remained [OR = 1.44 (95% CI: 1.16-1.81)]. CONCLUSIONS: Harmful alcohol habits were no commoner in men and women who belonged to the sample of incident sick-leave cases. Future studies are needed to analyse the predictive value of harmful alcohol habits on sickness absence length and the time until return to work after sickness absence.