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

AimTo explore antidiabetic medicine prescribing to women before, during and after pregnancyin different regions of Europe.MethodsA common protocol was implemented across seven databases in Denmark, Norway, TheNetherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK. Women with apregnancy 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) duringpregnancy and/or the year before or year after pregnancy were identified. Prescribing patternswere compared across databases and over calendar time.Results1,082,673 live/stillbirths were identified. Pregestational insulin prescribing during the yearbefore 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 / 17a11111OPEN ACCESSCitation: 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 SevenEuropean Regions. PLoS ONE 11(5): e0155737.doi:10.1371/journal.pone.0155737Editor: Harald Staiger, Medical Clinic, UniversityHospital Tuebingen, GERMANYReceived: October 5, 2015Accepted: May 3, 2016Published: May 18, 2016Copyright: © 2016 Charlton et al. This is an openaccess article distributed under the terms of theCreative Commons Attribution License, which permitsunrestricted use, distribution, and reproduction in anymedium, provided the original author and source arecredited.Data Availability Statement: All relevant data arewithin the paper and its Supporting Information files.The study used data from a number of databases andwhilst individual records for all databases wereanonymised, these individual patient data cannot bepublicly deposited or fully shared upon request, andare only available directly from the databaseproviders where appropriate.Funding: This study was part of the EUROmediCATresearch project (www.euromedicat.eu) which hasbeen supported by the European Commission underthe 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 trimesterprescribing was highest in Tuscany (2.2%) and lowest in Denmark (0.5%). Of those prescribedan insulin during pregnancy, between 50.5%in Denmark and 88.8% in the Netherlandsreceived an insulin analogue alone or in combination with human insulin, thisproportion increasing over time. Oral products were mainly metformin and prescribing washighest in the 3 months before pregnancy. Metformin use during pregnancy increased insome countries.ConclusionPregestational diabetes is increasing in many areas of Europe. There is considerable variationbetween and within countries in the choice of medication for treating pregestational diabetesin pregnancy, including choice of insulin analogues and oral antidiabetics, and verylarge variation in the treatment of gestational diabetes despite international guidelines.