Medication use in Northern Ireland in early pregnancy: Agreement between maternal self-report and prescribing records

Objective To assess the agreement between medication data reported by the mother at the pregnancy booking interview and recorded by midwives in the Northern Ireland Maternity System (NIMATS) compared to dispensed prescription data recorded in the Enhanced Prescribing Database (EPD). Method As part of a larger cross-sectional study investigating the prevalence of prescriptions dispensed between the last menstrual period (LMP) and the first antenatal visit 2011-2016, this sub-study assessed the agreement between self-reported medication use recorded in NIMATS and EPD compared to NIMATS, 2015-2016. Sensitivity and specificity compared to EPD were also calculated. This shorter time period was used due to underreporting of non-supplement medications before 2015 in NIMATS. Results Between 2015-2016, there were 34,432 pregnancies to 34,096 women. In NIMATS 96.8% of women reported taking medications during early pregnancy compared to 64.3% of women having prescriptions dispensed in EPD. Folic acid (low and high-dose) was the most common medication recorded in both NIMATS (57.2%) and EPD (26.2%). Antibiotics, analgesics, antacids and anticoagulants were more commonly recorded in NIMATS but all other non-supplement medications were more common in EPD. Agreement between NIMATS and EPD ranged from 2.6% for vitamins to 87.8% for insulin. Sensitivity ranged from 2.5% for cardiac medications to 84.3% for anticoagulants. Specificity ranged from 47.6% for antibiotics to 100% for cardiac and antiviral medications. Folic acid (low and high-dose), vitamins, antibiotics and analgesics were the only medications with specificity less than 90%. Conclusion Over-the-counter medications such as low-dose folic acid, antacids and analgesics were recorded more at the maternity booking interview (NIMATS), while medications requiring prescriptions were recorded more in EPD. This is important information for determining which data source to use in future studies assessing medication use

Use of prescribed contraception in Northern Ireland 2010-2016

Background The risk of an unintended, potentially unwanted, pregnancy is related to whether or not a woman uses any method of contraception and which method she uses. We do not know if, or how, contraceptive use in Northern Ireland (NI) varies by age or deprivation. If, as in the rest of the United Kingdom, the younger and most disadvantaged are least likely to use contraception, or to use effective methods of contraception, they will be at increased risk of having an unintended pregnancy. Objectives To describe the use of prescribed contraceptives in NI and explore how this varies based on a woman’s age and the deprivation in the area in which she lives. As the prescriber plays a critical role in determining medication use we will also explore how the use of prescribed contraceptives varies based on characteristics of the woman’s general practice (GP) such as size of practice, urban/rural practice location and practice area deprivation. Method A population based cohort study, is being conducted through the Honest Broker Service, linking the GP Register to the Enhanced Prescribing database and 2017 NI Multiple Deprivation Measure for all females of reproductive age 2010-2016. Research based on administrative data is free from recall and social desirability bias, which may be present in surveys of contraceptive use. Administrative data cannot however identify use of over-the-counter contraceptives. Findings This project is still in progress and results will be available by the time of the conference. Based on the NI Statistics and Research Agency Mid-Year Population Estimates and the Business Services Organisation Pharmaceutical statistics there were an estimated 472,875 females between the ages of 12 and 49 living in NI 2010-2016 with 2,316,075 prescriptions for a contraceptive. Conclusions Administrative data should be regularly analysed to understand contraceptive use patterns, and address inequalities

Risk factors for admission and length of stay in hospital for children with and without congenital anomalies: A EUROlinkCAT study

Objective To explore risk factors for hospital admission, and length of stay (LOS) in hospital, among children with congenital anomalies (CAs) and reference children without CAs in Europe. Method A European population-based data-linkage cohort study was conducted including children with CAs (born 1995-2014) registered in seven EUROCAT CA registries and children without CAs (reference children) living in the same geographical areas. Data on hospitalisation and LOS (1995-2015) for all children aged <1 year and 1-4 years were obtained by linkage to hospital discharge databases. The effects of birth cohort, sex, gestational age, maternal age, multiple birth and socioeconomic status on risk of admission and LOS were estimated using Cox’s Proportional Hazards and negative binomial regression models. Random effects meta-analysis and quantile estimation methods were used to pool the estimates. Results A total of 79,036 children with CAs and 2,016,042 reference children were linked to hospital records. Children with CAs born pre-term (<32 weeks) were more than twice as likely to be admitted (adj. HR 2.35, 95% CI 1.45-3.80) and had almost 8 times longer stays (adj. IRR 7.95, 95% CI 6.12-10.33) compared to children with CAs born at term. Reference children were almost six times as likely to be admitted (adj. HR 5.87, 95% CI 3.10-11.09), and had almost 50 times longer stays (adj. IRR 49.49, 30.92-79.21) compared to reference children born at term. Children with CAs and reference children born preterm were also at increased risk of admission at 1-4 years of age, although the effect was less than for children aged <1 year. Conclusion The impact of risk factors for admission to hospital and LOS were similar between children with CAs and reference children but the impact was often greater in reference children. This study highlights the value of linking to hospital discharge records to obtain population-based information on morbidity for counselling parents

An inventory of European data sources to support pharmacoepidemiologic research on neurodevelopmental outcomes in children following medication exposure in pregnancy: A contribution from the ConcePTION project

BACKGROUND: Studies on medication safety in pregnancy are increasingly focusing on child neurodevelopmental outcomes. Establishing neurodevelopmental safety is complex due to the range of neurodevelopmental outcomes and the length of follow-up needed for accurate assessment. The aim of this study was to provide an inventory of European data sources for use in pharmacoepidemiologic studies investigating neurodevelopment following maternal medication exposure. METHOD: The EUROmediSAFE inventory of data sources in Europe for evaluating perinatal and long-term childhood risks associated with in-utero exposure to medication was updated by contacting colleagues across 31 European countries, literature review and internet searches. Included data sources must record at least one neurodevelopmental outcome and maternal medication use in pregnancy must be available, either in the data source itself or through linkage with another data source. Information on the domain of neurodevelopment, measure/scale used and the approach to measurement were recorded for each data source. RESULTS: Ninety data sources were identified across 14 countries. The majority (63.3%) were created for health surveillance and research with the remaining serving administrative purposes (21.1% healthcare databases,15.6% other administrative databases). Five domains of neurodevelopment were identified—infant development (36 data sources,13 countries), child behaviour (27 data sources, 10 countries), cognition (29 data sources, 12 countries), educational achievement (20 data sources, 7 countries), and diagnostic codes for neurodevelopmental disorders (42 data sources, 11 countries). Thirty-nine data sources, in 12 countries, had information on more than one domain of neurodevelopment. CONCLUSION: This inventory is invaluable to future studies planning to investigate the neurodevelopmental impact of medication exposures during pregnancy. Caution must be used when combining varied approaches to neurodevelopment outcome measurement, the age of children in the data source, and the sensitivity and specificity of the outcome measure selected should be borne in mind