Antibiotic use during pregnancy in Sweden: A nationwide utilization study covering 2007-2019.
Sweden
antibacterials
antibiotics
post-pregnancy
postpartum
pre-conception
pre-pregnancy
pregnancy
puerperium
Journal
Acta obstetricia et gynecologica Scandinavica
ISSN: 1600-0412
Titre abrégé: Acta Obstet Gynecol Scand
Pays: United States
ID NLM: 0370343
Informations de publication
Date de publication:
18 Dec 2023
18 Dec 2023
Historique:
revised:
08
11
2023
received:
19
07
2023
accepted:
16
11
2023
medline:
18
12
2023
pubmed:
18
12
2023
entrez:
18
12
2023
Statut:
aheadofprint
Résumé
Antibiotics are often prescribed during pregnancy. Assessing the current state of prenatal antibiotic use is therefore imperative for optimizing prescribing and identifying emerging research priorities. The study aimed to describe recent trends and patterns in antibiotic use during pregnancy among women who gave birth in Sweden, including user characteristics. Population-based descriptive study using linked nationwide registers. All pregnancies delivered in Sweden from 2007 to 2019 were included. Prevalence of use was defined as the percentage of pregnancies during which at least one prescription forantibiotics was filled. Temporal trends in the prevalence of antibiotic use by calendar year, trimester and weeks of gestation were assessed from time series graphs. Prescriptions for systemic antibiotics were filled in 20.7% of 1 434 431 pregnancies overall, decreasing from 24.7% in 2007 to 18.0% in 2019. Phenoxymethylpenicillin (8.5%), pivmecillinam (6.5%), nitrofurantoin (4.7%), amoxicillin (1.6%) and cefadroxil (1.5%) use were the most prevalent. Their use decreased over the 13-year period, except for pivmecillinam, which increased from 4.0% to 7.4%. Prevalence of use was highest in the second trimester (9.5%), with weekly trends peaking at 13 and 34 weeks of gestation. Compared with non-users, antibiotic users more often belonged to the youngest and oldest age strata, carried multipleton pregnancies, had delivered before, had attained a lower education level and smoked in early pregnancy. A higher body mass index, asthma, chronic renal disease and diabetes mellitus were more prevalent among antibiotic users than among non-users. Although outpatient antibiotic use during pregnancy in Sweden has been declining, one in five pregnancies was exposed to systemic antibiotics.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).
Références
Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Global Health. 2014;2:e323-e333.
Chen L, Wang Q, Gao Y, et al. The global burden and trends of maternal sepsis and other maternal infections in 204 countries and territories from 1990 to 2019. BMC Infect Dis. 2021;21:1074.
Goldenberg RL, Culhane JF, Johnson DC. Maternal infection and adverse fetal and neonatal outcomes. Clin Perinatol. 2005;32:523-559.
Stephansson O, Granath F, Svensson T, Haglund B, Ekbom A, Kieler H. Drug use during pregnancy in Sweden - assessed by the prescribed drug register and the medical birth register. Clin Epidemiol. 2011;3:43-50.
Artama M, Gissler M, Malm H, Ritvanen A. Nationwide register-based surveillance system on drugs and pregnancy in Finland 1996-2006. Pharmacoepidemiol Drug Saf. 2011;20:729-738.
Engeland A, Bjørge T, Klungsøyr K, Hjellvik V, Skurtveit S, Furu K. Trends in prescription drug use during pregnancy and postpartum in Norway, 2005 to 2015. Pharmacoepidemiol Drug Saf. 2018;27:995-1004.
Mitchell AA, Gilboa SM, Werler MM, Kelley KE, Louik C, Hernández-Díaz S. Medication use during pregnancy, with particular focus on prescription drugs: 1976-2008. AmJ Obstet Gynecol. 2011;205(51):e51-e58.
Lupattelli A, Spigset O, Twigg MJ, et al. Medication use in pregnancy: a cross-sectional, multinational web-based study. BMJ Open. 2014;4:e004365.
Broe A, Pottegard A, Lamont RF, Jorgensen JS, Damkier P. Increasing use of antibiotics in pregnancy during the period 2000-2010: prevalence, timing, category, and demographics. BJOG. 2014;121:988-996.
Amann U, Egen-Lappe V, Strunz-Lehner C, Hasford J. Antibiotics in pregnancy: analysis of potential risks and determinants in a large German statutory sickness fund population. Pharmacoepidemiol Drug Saf. 2006;15:327-337.
de Jonge L, Bos HJ, van Langen IM, de Jong-van den Berg LT, Bakker MK. Antibiotics prescribed before, during and after pregnancy in The Netherlands: a drug utilization study. Pharmacoepidemiol Drug Saf. 2014;23:60-68.
Trinh NTH, Hjorth S, Nordeng HME. Use of interrupted time-series analysis to characterise antibiotic prescription fills across pregnancy: a Norwegian nationwide cohort study. BMJ Open. 2021;11:e050569.
Tran A, Zureik M, Sibiude J, et al. Prevalence and associated factors of antibiotic exposure during pregnancy in a large French population-based study during the 2010-19 period. J Antimicrob Chemother. 2023;78:2535-2543.
Stokholm J, Schjorring S, Pedersen L, et al. Prevalence and predictors of antibiotic administration during pregnancy and birth. PloS One. 2013;8:e82932.
Yefet E, Schwartz N, Chazan B, Salim R, Romano S, Nachum Z. The safety of quinolones and fluoroquinolones in pregnancy: a meta-analysis. BJOG. 2018;125:1069-1076.
Antonucci R, Cuzzolin L, Locci C, Dessole F, Capobianco G. Use of azithromycin in pregnancy: more doubts than certainties. Clin Drug Investig. 2022;42:921-935.
Cnattingius S, Källén K, Sandström A, et al. The Swedish medical birth register during five decades: documentation of the content and quality of the register. Eur J Epidemiology. 2023;38:109-120.
Wettermark B, Hammar N, Fored CM, et al. The new Swedish prescribed drug register-opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiol Drug Saf. 2007;16:726-735.
Ludvigsson JF, Svedberg P, Olén O, Bruze G, Neovius M. The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research. Eur J Epidemiol. 2019;34:423-437.
Ludvigsson JF, Almqvist C, Bonamy AK, et al. Registers of the Swedish total population and their use in medical research. EurJ Epidemiol. 2016;31:125-136.
INFPREG. Kunskscapscentrum för infectioner under graviditet. Antibiotika under Graviditet. Accessed September 30, 2023. https://www.medscinet.se/infpreg/healthcareinfoMore.aspx?topic=36
Public Health Agency of Sweden, Swedish Medical Products Agency, Strama. Behandlingsrekommendationer för vanliga infektioner i öppenvård. [Treatment recommendations for common infections in outpatient care]. 2022.
Danish Health Data Agency. Brug af laegemidler under graviditet. Accessed September 30, 2023. https://www.esundhed.dk/Emner/Laegemidler/Brug-af-laegemidler-under-graviditet
Petersen I, Gilbert R, Evans S, Ridolfi A, Nazareth I. Oral ant prescribing during pregnancy in primary care: UK population-based study. J Antimicrob Chemother. 2010;65:2238-2246.
Mölstad S, Löfmark S, Carlin K, et al. Lessons learnt during 20 years of the Swedish strategic programme against antibiotic resistance. Bull World Health Organ. 2017;95:764-773.
Public Health Agency of Sweden, National Veterinary Institute. Swedres-Svarm 2021. Sales of antibiotics and occurrence of resistance in Sweden. Solna/Uppsala ISSN1650-6332.
European Centre for Disease Prevention and Control. Antimicrobial consumption in the EU/EEA, annual epidemiological report for 2020. Stockholm. 2019.
Kalinderi K, Delkos D, Kalinderis M, Athanasiadis A, Kalogiannidis I. Urinary tract infection during pregnancy: current concepts on a common multifaceted problem. J Obstet Gynaecol. 2018;38:448-453.
Lindbäck H, Lindbäck J, Melhus Å. Inadequate adherence to Swedish guidelines for uncomplicated lower urinary tract infections among adults in general practice. APMIS. 2017;125:816-821.
Frimodt-Møller N, Simonsen GS, Larsen AR, Kahlmeter G. Pivmecillinam, the paradigm of an antibiotic with low resistance rates in Escherichia coli urine isolates despite high consumption. J Antimicrob Chemother. 2022;78:289-295.
Wolgast E, Lindh-Åstrand L, Lilliecreutz C. Women's perceptions of medication use during pregnancy and breastfeeding-a Swedish cross-sectional questionnaire study. Acta Obstet Gynecol Scand. 2019;98:856-864.
Fossum GH, Gjelstad S, Kvaerner KJ, Lindbaek M. Prescribing antibiotics when the stakes are higher - do GPs prescribe less when patients are pregnant? A retrospective observational study. BJGP Open. 2018;2:bjgpopen18X101505.
The Swedish Society of Obstetrics and Gynaecology. Mödrahälsovård, Sexuell och Reproduktiv Hälsa. Rapport nr 76. [maternal health care, sexual and reproductive health. Report No. 76.]. In: Swedish. Svensk förening för obstetrik och gynekologi (SOFG), Stockholm. 2016.
Crowe HM, Hatch EE, Wang TR, et al. Periconceptional antibiotic use and spontaneous abortion: a prospective cohort study. Paediatr Perinat Epidemiol. 2023;37:179-187.
Omranipoor A, Kashanian M, Dehghani M, Sadeghi M, Baradaran HR. Association of antibiotics therapy during pregnancy with spontaneous miscarriage: a systematic review and meta-analysis. Arch Gynecol Obstet. 2020;302:5-22.
Axelsson D, Brynhildsen J, Blomberg M. Postpartum infection in relation to maternal characteristics, obstetric interventions and complications. J Perinat Med. 2018;46:271-278.
Axelsson D, Blomberg M. Prevalence of postpartum infections: a population-based observational study. Acta Obstet Gynecol Scand. 2014;93:1065-1068.
Larsson P-G, Poutakidis G, Adolfsson A, Charonis G, Pasi B, Ekström L. Treatment of bacterial vaginosis in early pregnancy and its effect on spontaneous preterm delivery and preterm rupture of membranes. Clin Microbiol. 2016;5:1000259.
Rizzardi K, Norén T, Aspevall O, et al. National Surveillance for Clostridioides difficile infection, Sweden, 2009-2016. Emerg Infect Dis. 2018;24:1617-1625.