Prescriptions for contraindicated category X drugs in pregnancy among women enrolled in TennCare
Prescriptions for contraindicated category X drugs in pregnancy among women enrolled in TennCare
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DOI：
10.1111/j.1365-3016.2003.00542.x
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发表时间：
2004-03-01
影响因子：
2.8
通讯作者：
Ray, WA
中科院分区：
文献类型：
--
作者：
Cooper, WO;Hickson, GB;Ray, WA
在田纳西州 TennCare 项目（针对医疗补助参与者和没有健康保险的个人）注册的 95 284 名女性中，确定了服用美国食品和药物管理局标记为 X 类药物（被认为怀孕期间禁用）的处方药物。使用行政索赔数据，391 名女性 (4.10/1000) 被确定为在怀孕期间服用过 X 类处方药。其中包括 118 名女性 (1.24/1000) 服用非避孕雌激素处方药，81 名女性 (0.85/1000) 服用镇静剂，71 名女性 (0.75/1000) 服用他汀类药物。虽然许多女性就诊时得到的诊断结果与妊娠期以外的某种药物的可能适应症一致，但这些适应症均不包括在怀孕期间使用。老年女性和残疾女性比年轻女性 (P < 0.0001) 和因其他原因注册的女性 (P < 0.0001) 更有可能配药 X 类处方。在 391 名女性中，近三分之二在临床症状或妊娠测试表明怀孕后服用了处方；近 40% 的人在与怀孕相关的医生就诊后服用了 X 类处方药。尽管怀孕期间使用 X 类药物的绝对率较低，但仍有大量妇女及其胎儿在怀孕期间接触过 X 类药物。 35 岁以上的女性和因残疾而加入 TennCare 的女性比其他人更有可能在怀孕期间服用 X 类药物的处方，这意味着与从业者和女性的风险沟通应重点关注这些女性的识别，以降低她们的暴露风险。
Filling of prescriptions for medications labelled as category X by the United States Food and Drug Administration (considered to be contraindicated for use in pregnancy) was identified among 95 284 women enrolled in TennCare, Tennessee's programme for Medicaid enrollees and individuals without health insurance. Using administrative claims data, 391 women (4.10/1000) were identified as having filled category X prescriptions during pregnancy. This included 118 women (1.24/1000) who filled prescriptions for non-contraceptive oestrogens, 81 (0.85/1000) for sedatives, and 71 (0.75/1000) for statins. While many women had physician visits with a diagnosis consistent with a possible indication for an individual drug outside of pregnancy, none of these indications is included for use during pregnancy. Older women and disabled women were more likely than younger women (P < 0.0001) and women enrolled for other reasons (P < 0.0001) to fill category X prescriptions. Nearly two-thirds of the 391 women filled prescriptions after clinical signs or pregnancy tests would indicate pregnancy; nearly 40% filled a category X prescription after a pregnancy-related physician visit. Although the absolute rate of category X medication use in pregnancy is low, substantial numbers of women and their fetuses are exposed during pregnancy. Women above the age of 35 years and women enrolled in TennCare because of disabilities were more likely to fill prescriptions for category X medications during pregnancy than others, implying that risk communication to practitioners and women should focus on identification of these women to reduce their risk of exposure.