Prescribing of antidiabetic medicines before, during and after pregnancy: a study in seven European regions

Aim To explore antidiabetic medicine prescribing to women before, during and after pregnancy in different regions of Europe. Methods A common protocol was implemented across seven databases in Denmark, Norway, The Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK. Women with a pregnancy starting and ending between 2004 and 2010, (Denmark, 2004-2009; Norway, 2005-2010; Emilia Romagna, 2008-2010), which ended in a live or stillbirth, were identified. Prescriptions for antidiabetic medicines issued (UK) or dispensed (non-UK) during pregnancy and/or the year before or year after pregnancy were identified. Prescribing patterns were compared across databases and over calendar time. Results 1,082,673 live/stillbirths were identified. Pregestational insulin prescribing during the year before pregnancy ranged from 0.27%(CI95 0.25-0.30) in Tuscany to 0.45% (CI95 0.43- PLOS ONE | DOI:10.1371/journal.pone.0155737 May 18, 2016 1 / 17 a11111 OPEN ACCESS Citation: Charlton RA, Klungsøyr K, Neville AJ, Jordan S, Pierini A, de Jong-van den Berg LTW, et al. (2016) Prescribing of Antidiabetic Medicines before, during and after Pregnancy: A Study in Seven European Regions. PLoS ONE 11(5): e0155737. doi:10.1371/journal.pone.0155737 Editor: Harald Staiger, Medical Clinic, University Hospital Tuebingen, GERMANY Received: October 5, 2015 Accepted: May 3, 2016 Published: May 18, 2016 Copyright: © 2016 Charlton et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. The study used data from a number of databases and whilst individual records for all databases were anonymised, these individual patient data cannot be publicly deposited or fully shared upon request, and are only available directly from the database providers where appropriate. Funding: This study was part of the EUROmediCAT research project (www.euromedicat.eu) which has been supported by the European Commission under the 7th Framework Programme Grant agreement n° 0.47) in Norway, and increased between 2004 and 2009 in all countries. During pregnancy, insulin prescribing peaked during the third trimester and increased over time; third trimester prescribing was highest in Tuscany (2.2%) and lowest in Denmark (0.5%). Of those prescribed an insulin during pregnancy, between 50.5%in Denmark and 88.8% in the Netherlands received an insulin analogue alone or in combination with human insulin, this proportion increasing over time. Oral products were mainly metformin and prescribing was highest in the 3 months before pregnancy. Metformin use during pregnancy increased in some countries. Conclusion Pregestational diabetes is increasing in many areas of Europe. There is considerable variation between and within countries in the choice of medication for treating pregestational diabetes in pregnancy, including choice of insulin analogues and oral antidiabetics, and very large variation in the treatment of gestational diabetes despite international guidelines.