Prescribing of Antidiabetic Medicines before, during and after Pregnancy: A Study in Seven European Regions

Rachel Charlton, Kari Klungsoyr, Amanda Neville, Sue Jordan, Anna Pierini, Lolkje de Jong-van den Berg, Jens Bos, Aurora Puccini, Anders Engeland, Rosa Gini, Gareth Davies, Daniel Thayer, Anne V Hansen, Margery Morgan, Hao Wang, Anita McGrogan, Anne-Marie Nybo Andersen, Helen Dolk, Ester Garne

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

AimTo explore antidiabetic medicine prescribing to women before, during and after pregnancy in different regions of Europe.MethodsA common protocol was implemented across seven databases in Denmark, Norway, The Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK. Women with a pregnancy starting and ending between 2004 and 2010, (Denmark, 2004–2009; Norway, 2005–2010; Emilia Romagna, 2008–2010), which ended in a live or stillbirth, were identified. Prescriptions for antidiabetic medicines issued (UK) or dispensed (non-UK) during pregnancy and/or the year before or year after pregnancy were identified. Prescribing patternswere compared across databases and over calendar time.Results1,082,673 live/stillbirths were identified. Pregestational insulin prescribing during the year before pregnancy ranged from 0.27%(CI95 0.25–0.30) in Tuscany to 0.45% (CI95 0.43–0.47) in Norway, and increased between 2004 and 2009 in all countries. During pregnancy, insulin prescribing peaked during the third trimester and increased over time; third trimester prescribing was highest in Tuscany (2.2%) and lowest in Denmark (0.5%). Of those prescribed an insulin during pregnancy, between 50.5%in Denmark and 88.8% in the Netherlandsreceived an insulin analogue alone or in combination with human insulin, this proportion increasing over time. Oral products were mainly metformin and prescribing was highest in the 3 months before pregnancy. Metformin use during pregnancy increased in some countries.ConclusionPregestational diabetes is increasing in many areas of Europe. There is considerable variation between and within countries in the choice of medication for treating pregestational diabetes in pregnancy, including choice of insulin analogues and oral antidiabetics, and very large variation in the treatment of gestational diabetes despite international guidelines.
LanguageEnglish
Pages1-17
JournalPLoS ONE
Volume11
Issue number5
Early online date18 May 2016
DOIs
Publication statusE-pub ahead of print - 18 May 2016

Fingerprint

Hypoglycemic Agents
Pregnancy
Denmark
Insulin
Norway
Stillbirth
Metformin
Third Pregnancy Trimester
Databases
Pregnancy in Diabetics
Gestational Diabetes
Wales
Netherlands
Italy
Prescriptions
Medicine
Guidelines

Keywords

  • EUROmediCAT
  • Antidiabetic medicines

Cite this

Charlton, R., Klungsoyr, K., Neville, A., Jordan, S., Pierini, A., de Jong-van den Berg, L., ... Garne, E. (2016). Prescribing of Antidiabetic Medicines before, during and after Pregnancy: A Study in Seven European Regions. PLoS ONE, 11(5), 1-17. https://doi.org/10.1371/journal.pone.0155737
Charlton, Rachel ; Klungsoyr, Kari ; Neville, Amanda ; Jordan, Sue ; Pierini, Anna ; de Jong-van den Berg, Lolkje ; Bos, Jens ; Puccini, Aurora ; Engeland, Anders ; Gini, Rosa ; Davies, Gareth ; Thayer, Daniel ; Hansen, Anne V ; Morgan, Margery ; Wang, Hao ; McGrogan, Anita ; Nybo Andersen, Anne-Marie ; Dolk, Helen ; Garne, Ester. / Prescribing of Antidiabetic Medicines before, during and after Pregnancy: A Study in Seven European Regions. In: PLoS ONE. 2016 ; Vol. 11, No. 5. pp. 1-17.
@article{49b9553a2d824ce78d7a8bad3e4fae8b,
title = "Prescribing of Antidiabetic Medicines before, during and after Pregnancy: A Study in Seven European Regions",
abstract = "AimTo explore antidiabetic medicine prescribing to women before, during and after pregnancy in different regions of Europe.MethodsA common protocol was implemented across seven databases in Denmark, Norway, The Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK. Women with a pregnancy starting and ending between 2004 and 2010, (Denmark, 2004–2009; Norway, 2005–2010; Emilia Romagna, 2008–2010), which ended in a live or stillbirth, were identified. Prescriptions for antidiabetic medicines issued (UK) or dispensed (non-UK) during pregnancy and/or the year before or year after pregnancy were identified. Prescribing patternswere compared across databases and over calendar time.Results1,082,673 live/stillbirths were identified. Pregestational insulin prescribing during the year before pregnancy ranged from 0.27{\%}(CI95 0.25–0.30) in Tuscany to 0.45{\%} (CI95 0.43–0.47) in Norway, and increased between 2004 and 2009 in all countries. During pregnancy, insulin prescribing peaked during the third trimester and increased over time; third trimester prescribing was highest in Tuscany (2.2{\%}) and lowest in Denmark (0.5{\%}). Of those prescribed an insulin during pregnancy, between 50.5{\%}in Denmark and 88.8{\%} in the Netherlandsreceived an insulin analogue alone or in combination with human insulin, this proportion increasing over time. Oral products were mainly metformin and prescribing was highest in the 3 months before pregnancy. Metformin use during pregnancy increased in some countries.ConclusionPregestational diabetes is increasing in many areas of Europe. There is considerable variation between and within countries in the choice of medication for treating pregestational diabetes in pregnancy, including choice of insulin analogues and oral antidiabetics, and very large variation in the treatment of gestational diabetes despite international guidelines.",
keywords = "EUROmediCAT, Antidiabetic medicines",
author = "Rachel Charlton and Kari Klungsoyr and Amanda Neville and Sue Jordan and Anna Pierini and {de Jong-van den Berg}, Lolkje and Jens Bos and Aurora Puccini and Anders Engeland and Rosa Gini and Gareth Davies and Daniel Thayer and Hansen, {Anne V} and Margery Morgan and Hao Wang and Anita McGrogan and {Nybo Andersen}, Anne-Marie and Helen Dolk and Ester Garne",
year = "2016",
month = "5",
day = "18",
doi = "10.1371/journal.pone.0155737",
language = "English",
volume = "11",
pages = "1--17",
journal = "PLoS ONE",
issn = "1932-6203",
number = "5",

}

Charlton, R, Klungsoyr, K, Neville, A, Jordan, S, Pierini, A, de Jong-van den Berg, L, Bos, J, Puccini, A, Engeland, A, Gini, R, Davies, G, Thayer, D, Hansen, AV, Morgan, M, Wang, H, McGrogan, A, Nybo Andersen, A-M, Dolk, H & Garne, E 2016, 'Prescribing of Antidiabetic Medicines before, during and after Pregnancy: A Study in Seven European Regions', PLoS ONE, vol. 11, no. 5, pp. 1-17. https://doi.org/10.1371/journal.pone.0155737

Prescribing of Antidiabetic Medicines before, during and after Pregnancy: A Study in Seven European Regions. / Charlton, Rachel; Klungsoyr, Kari; Neville, Amanda; Jordan, Sue; Pierini, Anna; de Jong-van den Berg, Lolkje; Bos, Jens; Puccini, Aurora; Engeland, Anders; Gini, Rosa; Davies, Gareth; Thayer, Daniel; Hansen, Anne V; Morgan, Margery; Wang, Hao; McGrogan, Anita; Nybo Andersen, Anne-Marie; Dolk, Helen; Garne, Ester.

In: PLoS ONE, Vol. 11, No. 5, 18.05.2016, p. 1-17.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prescribing of Antidiabetic Medicines before, during and after Pregnancy: A Study in Seven European Regions

AU - Charlton, Rachel

AU - Klungsoyr, Kari

AU - Neville, Amanda

AU - Jordan, Sue

AU - Pierini, Anna

AU - de Jong-van den Berg, Lolkje

AU - Bos, Jens

AU - Puccini, Aurora

AU - Engeland, Anders

AU - Gini, Rosa

AU - Davies, Gareth

AU - Thayer, Daniel

AU - Hansen, Anne V

AU - Morgan, Margery

AU - Wang, Hao

AU - McGrogan, Anita

AU - Nybo Andersen, Anne-Marie

AU - Dolk, Helen

AU - Garne, Ester

PY - 2016/5/18

Y1 - 2016/5/18

N2 - AimTo explore antidiabetic medicine prescribing to women before, during and after pregnancy in different regions of Europe.MethodsA common protocol was implemented across seven databases in Denmark, Norway, The Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK. Women with a pregnancy starting and ending between 2004 and 2010, (Denmark, 2004–2009; Norway, 2005–2010; Emilia Romagna, 2008–2010), which ended in a live or stillbirth, were identified. Prescriptions for antidiabetic medicines issued (UK) or dispensed (non-UK) during pregnancy and/or the year before or year after pregnancy were identified. Prescribing patternswere compared across databases and over calendar time.Results1,082,673 live/stillbirths were identified. Pregestational insulin prescribing during the year before pregnancy ranged from 0.27%(CI95 0.25–0.30) in Tuscany to 0.45% (CI95 0.43–0.47) in Norway, and increased between 2004 and 2009 in all countries. During pregnancy, insulin prescribing peaked during the third trimester and increased over time; third trimester prescribing was highest in Tuscany (2.2%) and lowest in Denmark (0.5%). Of those prescribed an insulin during pregnancy, between 50.5%in Denmark and 88.8% in the Netherlandsreceived an insulin analogue alone or in combination with human insulin, this proportion increasing over time. Oral products were mainly metformin and prescribing was highest in the 3 months before pregnancy. Metformin use during pregnancy increased in some countries.ConclusionPregestational diabetes is increasing in many areas of Europe. There is considerable variation between and within countries in the choice of medication for treating pregestational diabetes in pregnancy, including choice of insulin analogues and oral antidiabetics, and very large variation in the treatment of gestational diabetes despite international guidelines.

AB - AimTo explore antidiabetic medicine prescribing to women before, during and after pregnancy in different regions of Europe.MethodsA common protocol was implemented across seven databases in Denmark, Norway, The Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK. Women with a pregnancy starting and ending between 2004 and 2010, (Denmark, 2004–2009; Norway, 2005–2010; Emilia Romagna, 2008–2010), which ended in a live or stillbirth, were identified. Prescriptions for antidiabetic medicines issued (UK) or dispensed (non-UK) during pregnancy and/or the year before or year after pregnancy were identified. Prescribing patternswere compared across databases and over calendar time.Results1,082,673 live/stillbirths were identified. Pregestational insulin prescribing during the year before pregnancy ranged from 0.27%(CI95 0.25–0.30) in Tuscany to 0.45% (CI95 0.43–0.47) in Norway, and increased between 2004 and 2009 in all countries. During pregnancy, insulin prescribing peaked during the third trimester and increased over time; third trimester prescribing was highest in Tuscany (2.2%) and lowest in Denmark (0.5%). Of those prescribed an insulin during pregnancy, between 50.5%in Denmark and 88.8% in the Netherlandsreceived an insulin analogue alone or in combination with human insulin, this proportion increasing over time. Oral products were mainly metformin and prescribing was highest in the 3 months before pregnancy. Metformin use during pregnancy increased in some countries.ConclusionPregestational diabetes is increasing in many areas of Europe. There is considerable variation between and within countries in the choice of medication for treating pregestational diabetes in pregnancy, including choice of insulin analogues and oral antidiabetics, and very large variation in the treatment of gestational diabetes despite international guidelines.

KW - EUROmediCAT

KW - Antidiabetic medicines

U2 - 10.1371/journal.pone.0155737

DO - 10.1371/journal.pone.0155737

M3 - Article

VL - 11

SP - 1

EP - 17

JO - PLoS ONE

T2 - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 5

ER -

Charlton R, Klungsoyr K, Neville A, Jordan S, Pierini A, de Jong-van den Berg L et al. Prescribing of Antidiabetic Medicines before, during and after Pregnancy: A Study in Seven European Regions. PLoS ONE. 2016 May 18;11(5):1-17. https://doi.org/10.1371/journal.pone.0155737