[Drug use during pregnancy, labor and the puerperium and after the Drug Use in Pregnancy Study]

An international study on drug use in pregnancy (DUP) started in 1987. There were 22 countries involved, among which two centers from Yugoslavia: Novi Sad and Zagreb. The investigation in Novi Sad comprised 296 parturients. On the basis of obtained results, education of physicians-gynecologists has been organized. 10 years later, a check-up study of 100 parturients was introduced in order to find out possible changes in the applied pharmacotherapy.

An investigation on drug use in pregnancy, delivery and puerperium has been performed at the Department of Obstetrics and Gynecology in Novi Sad. It included 296 parturients in 1989 (1st investigated period) and 100 parturients in 1999 (2nd investigated period). Results obtained in 1999 were compared with the results from 1989.

Chronic use of drugs was found similar for both investigated periods (2.38% in 1989 vs 5% in 1999). In this group there were no drugs which could endanger the fetus. In 1989, there were 12.6% of pregnant women using preparations such as iron supply, versus 54% in 1999, so that trends in prevention of pharmacotherapy of anemia approached those in developed countries. In the second investigated period there was a significant decrease in progresterone therapy and two times increased use of beta-adrenergic agonists, which is in accordance with new trends in pharmacology. Use of paracetamol decreased, whereas use of metamizole, known by serious side-effects, increased. Drug administration during delivery decreased in 1999 (77%) in relation to 1989 (94.93%) mostly comprising drugs for autonomous nervous system, analgesics and analgoantipyretics. Administration of ergot-alkaloids decreased: from 65.8% in 1989 to 22% in 1999. Use of drugs after delivery can endanger both the parturient and lactation, i.e. nutrition of the newborn infant and consequently the newborn itself. During 1989 practically every parturient (95.27%) was administered drugs, out of which about 97% belonged to the group of ergot-alkaloids which were routinly administered for acceleration of uterine involution. In 1999 ergot-alkaloids were administered only in 9% of delivered women. Use of oxytocins was also reduced because they were administered not routinely but only on purpose.

The following conclusions were made on the basis of obtained data: 1. During the first period there was a difference in drug use when compared to the countries with developed pharmacotherapeutic practice. 2. Use of progesterones was remarkably decreased in 1999 versus two times increased use of beta-adrenergic agonists administered in prevention of spontaneous abortions. 3. Use of opiate analgesics during delivery was significantly reduced from 43% to 11% in 1999. 4. In the second investigated period use of iron preparations was significantly increased versus decreased use of ergot-alkaloids. 5. Use of paracetamol decreased, whereas use of metamizole (known by serious side-effects) increased.