Nkohma E, Zhao Y, Esposito D, Mines D, Holick C. Patterns of medication use during pregnancy and prevalence of birth defects in a large administrative claims database. Poster presented at the 28th ICPE International Conference on Pharmacoepidemiology & Therapeutic Risk Management; August 2012. Barcelona, Spain. [abstract] Pharmacoepidemiol Drug Saf. 2012; 21(Suppl 3):390.

Background: Administrative claims databases may serve as pharmacovigilance tools for exposures during pregnancy given the capture of medication dispensings as well as maternal and neonatal outcomes in large populations.

Objectives: The aim of this analysis was to describe mother-infant pairs in a large insurance claims database with respect to maternal characteristics, medication use during pregnancy and frequency of birth defects.

Methods: This was a descriptive study of mother-infant pairs identified from 2001 to 2011 in the HealthCore Integrated Research Database (HIRDSM), a US commercial insurance claims database. We characterized pairs with respect to maternal factors and patterns of medication use during pregnancy by trimester. We also compared the computed prevalence of selected birth defects in the HIRD to published national estimates.

Results: We identified 696,201 infants born to 600,275 mothers (15.1% of mothers delivered >1 infant). Mothers had a mean age of 30.8 ± 5.1 years, and 61.3% were enrolled in the health plan for ‡12 months prior to delivery. Prior to pregnancy, 2.2% of mothers were diabetic and 1.5% had hypertension. Of the infants, 7.5% were premature and 7.1% were twins or other multiples. The most common classes of medications dispensed during pregnancy were analgesics, antiasthmatics and antidepressants. There was a strong increasing trend in first trimester use of anticonvulsants, vaccines and antihypertensives over time. The estimated prevalence of birth defects over the study period was much higher than published estimates at 580 per 10,000 live births. An increasing temporal trend was observed for certain cardiovascular and genitourinary anomalies. When compared to national estimates, the largest differences were observed for cardiovascular anomalies, with higher prevalence observed in the HIRD.

Conclusions: Large insurance claims databases can be useful for monitoring birth defects and medication usage during pregnancy. However, additional research is required to understand observed differences in the frequency of certain types of defects when compared to national estimates.

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