Drugs and pregnancy -project 2008 onwards

1. Drugs and pregnancy -project2008 onwards Miia Artama & Mika Gissler, Finland

2. Background information of the drug and pregnancy -project • Co-project of three governmental authorities: • the National Institute for Health and Welfare (THL), • the Social Insurance Institution (SII) of Finland • the National Agency for Medicines. • The project started in 2008 with the preceding pilot study conducted during 2003-2007. Miia Artama & Mika Gissler, Finland

3. Database • National Institute for Health and Welfare (THL) • Data on births and fetuses in TOP 1996-2012 and the mothers • Medical Birth Register • Register on Congenital Anomalies and Birth Defects • Register on Induced Abortions • KELA (Social Insurance Institution) • Drug Reimbursement Registers • medicines prescribed by a doctor / reimbursed by KELA and specially reimbursed medicines • 3 months before and during the pregnancy - 3 months after birth / TOP Miia Artama & Mika Gissler, Finland

4. Database • Case codes in separate registers • Key consisting of the case codes • Data can be formulated with the key => Anonymous research register • For research purposes of the project • For external researchers with permission Miia Artama & Mika Gissler, Finland

5. Aims of the project • To give information for governmental authorities for statutory duties on pregnancy related drug use and safety • To give information for other governmental authorities, health services, media, citizen etc. • To produce and maintain contacts with pharmaceutical industry regarding the safety of drug use during pregnancy • To collaborate with internal and international scientific society Miia Artama & Mika Gissler, Finland

6. Drug use in deliveries, one month prior to pregnancy or during pregnancy, 1996-2006 Miia Artama & Mika Gissler, Finland

7. Special reimbursements of certain diseases in deliveries 1996-2006 Miia Artama & Mika Gissler, Finland

8. Number of special reimbursements in deliveries, 1996-2006 Miia Artama & Mika Gissler, Finland

9. Most common chronic diseases in deliveries, 1996-2006 Miia Artama & Mika Gissler, Finland

10. Purchases related to the special reimbursement Miia Artama & Mika Gissler, Finland

11. Purchasers by timing Miia Artama & Mika Gissler, Finland

12. Most common drug purchases (ATC-2 -level) in deliveries, 1996-2006 Miia Artama & Mika Gissler, Finland

13. Most common drug purchases (ATC-3 -level) in deliveries, 1996-2006 Miia Artama & Mika Gissler, Finland

14. Most common drug purchases (ATC-5 -level) in deliveries, 1996-2006 Miia Artama & Mika Gissler, Finland

15. Conclusions • Half (48.5%) of parturients had drug purchases during pregnancy • Most common drugs were antibiotics • 6 percent of parturients had at least one chronic disease during pregnancy • Most common chronic diseases were asthma, hypothyreosis and epilepsy

16. Use of psychotropic drugs before pregnancy and the risk for induced abortion Gissler Mika, Artama Miia, Ritvanen Annukka, Wahlbeck Kristian THL National Institute for Health and Welfare, Helsinki, Finland & Nordic School of Public Health, Gothenburg, Sweden

17. Introduction • Some, but not all studies have reported increased risk for mental health problems after an induced abortion. • Problems with design and data have complicated these studies and the generalisation of their results.

18. Background • Finnish legislation requires a permission to terminate a pregnancy until 20 weeks (24 weeks for severe, confirmed congenital anomalies). Most often the permission is given for social ground. • The Finnish abortion rate is lower than in many countries (per 1000 women aged 15-49 years, year) • Finland 9/1000, 2007 • Other Nordic countries 14/1000 (12-17/1000), 2006 • England and Wales 15/1000, 2007 • United States 16/1000, 2005

19. Aim • We studied the use of psychotropic drugs within three months before the pregnancy started by the following background factors: • Age, civil status and socioeconomic position • Previous pregnancies, births and induced abortions • Pregnancies ending in a birth or an induced abortion were analysed separately.

20. Aim & Methods • The Finnish Medication and Pregnancy -database for years 1996-2006: • All pregnancies: 622 671 births and 114 518 induced abortions for other than fetal reasons. • First pregnancies: 197 120 births and 45 964 induced abortions for other than fetal reasons.

21. ATC categories • N05 or N06: any tranquilising, antidepressant or psychostimulant drug • N05A: antipsychotics • N05B: anxiolytics • N05C: hypnotics and sedatives • N06A: antidepressants • N06B: psychostimulants and nootropics (28 pregnancies) • N06C: psycholeptics and psychoanaleptics in combination

22. The use of psychotropic medicine 0-3 months before the pregnancy started, %

23. The proportion of terminated pregnancies, %

24. Crude and adjusted ORs for pregnancy termination, all pregnancies Adjusted by year, age, civil status, socioeconomic status and gravidity.

25. Crude and adjusted ORs for pregnancy termination, first pregnancies Adjusted by year, age, civil status and socioeconomic status.

26. Conclusions • Women’s pre-existing mental health status is different for women having an induced abortion than for women giving a birth. • According to the current Finnish recommendation, a post-abortion check-up visit is necessary a few weeks after the procedure to detect signs of depression and to identify the rare cases of psychosis after an induced abortion. Following this recommendation may diminish negative health consequences post-abortion. • This essential confounding factor should not be neglected when investigating the occurrence of pregnancy-related mental health problems.