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Medication use during pregnancy in Japan from 2005 to 2019: Trends and safety considerations
Motohiko Adomi1,2, Takamasa Sakai3, Tomofumi Ishikawa4
1Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Objective:
Recent data on patterns and trends of medication use during pregnancy are limited in Japan. This study aimed to evaluate annual trends of medication use during pregnancy in Japan and identify frequently dispensed medications with limited safety evidence.
Methods:
A descriptive study was conducted using a pregnancy cohort nested within the JMDC claims database (2005-2019). Dispensing of medications before pregnancy and during each pregnancy trimester were evaluated. Annual trends were examined at the class and subclass medication level. Availability of evidence on teratogenic risk was assessed for the top 30 most commonly dispensed medications during the first trimester using the TERIS database.
Results:
A total of 110 969 pregnancies (94 749 unique individuals) were included in the study. Acetaminophen was the most commonly dispensed medication across all windows. Other frequently dispensed medications included other analgesics, antiasthmatics, antibiotics, antiemetics, antiulcer medications, immunosuppressants, and thyroid medications. Annual trends revealed increased dispensing of analgesics (primarily acetaminophen), antiasthmatics (inhaled beta-2 agonists, inhaled corticosteroids, leukotriene receptor antagonists), antiemetics (metoclopramide), and thyroid medications (thyroid hormone). Over 60% of the 30 most commonly dispensed medications during the first trimester lacked sufficient teratogenic safety evidence, particularly for antiasthmatics, antibiotics, and antivirals.
Conclusion:
A significant proportion of medications commonly dispensed during pregnancy in Japan have inadequate teratogenic safety evidence. Several medication classes showed increasing utilization trends over the study period, emphasizing the urgent need for targeted safety evaluations in the Japanese population.
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