Inappropriate consumption of anxiolytic, sedative and hypnotic medication (ASH) in the elderly is... more Inappropriate consumption of anxiolytic, sedative and hypnotic medication (ASH) in the elderly is an important public health issue. Almost 35 % of the elderly population living at home take these medications, approximately 206 days per year. According to Quebec data, people who are 65 and older take five times more ASH than people between 18 and 64. The use of ASH would not only be determined by the presence of symptoms, but also by psychosocial characteristics of the subjects. Moreover, several researchers have suggested that the family as well as the health system were environmental factors that could facilitate or inhibit consumption of these medications in the elderly. A conceptual framework is proposed to help specify more adequately the various explanatory hypotheses of this social health behavior and, consequently, better target interventions aiming at its modification.
Canadian Journal of Clinical Pharmacology, Oct 24, 2008
Information on healthcare costs associated with poorly treated psychiatric disorders during and a... more Information on healthcare costs associated with poorly treated psychiatric disorders during and after pregnancy is limited. To compare the direct healthcare costs, during and after pregnancy, between women who continue their antidepressant therapy during the whole gestational period and those who discontinue their treatment during the first trimester. Data from a 'Medications and Pregnancy' registry were used. Eligible women were 1) aged 15 - 45, 2) insured by the Quebec drug plan for > or =12 months prior to, during, and > or =3 months after pregnancy, 3) had > or =1 diagnoses of psychiatric disorders before pregnancy, 4) used antidepressants for . or =30 days in the year before pregnancy, and 5) had delivered. Women who continued their antidepressant therapy throughout pregnancy (Group 1) were compared to those who discontinued during the first trimester (Group 2). Healthcare costs, expressed as mean total costs and cost ratios, were determined during and after pr...
BACKGROUND Development of knowledge in understanding the use of anti-infective drugs during pregn... more BACKGROUND Development of knowledge in understanding the use of anti-infective drugs during pregnancy has been limited by difficulties in testing medications in pregnant women and lack of evidence-based data. Overuse of broad spectra agents is associated with development and spread of bacterial resistance, a problem that is faced as a significant threat to the public health. OBJECTIVES To describe trends in use of general and broad spectrum anti-infective drugs during pregnancy. METHODS We used the Quebec Pregnancy Registry to analyse trends for use of oral anti-infectives dispensed during pregnancy for the five-year period comprised between January 1998 and December 2002. Trends in use were assessed for classes of anti-infectives and for broad-spectrum drugs. Descriptive statistics were used to summarize the characteristics of the study population. Annual trends for the use of anti-infective drugs were analyzed using the Cochran-Armitage test. RESULTS The use of anti-infective drug...
Resume Objectif : Decrire et evaluer l’impact d’une intervention pharmaceutique sur l’observance ... more Resume Objectif : Decrire et evaluer l’impact d’une intervention pharmaceutique sur l’observance therapeutique de femmes enceintes atteintes du virus d’immunodeficience humaine sous traitement antiretroviral. Methodologie : Etude pilote portant sur des femmes enceintes atteintes du virus d’immunodeficience humaine, suivies a la clinique externe du Centre hospitalier universitaire Sainte-Justine de novembre 2004 a mai 2005. Lors du suivi mensuel, deux interventions du pharmacien avaient ete planifiees, a deux mois d’intervalle. L’observance a ete mesuree a l’aide de trois outils : un questionnaire, le decompte des comprimes et l’historique des renouvellements. Resultats : Le taux moyen de patientes observantes est passe de 75 % (n = 8) a 63 % (n = 8) selon le questionnaire, il est passe de 85 % (n =16 flacons de medicaments) a 97 % (n = 13 flacons de medicaments) selon le decompte des comprimes, alors qu’il est demeure inchange avec l’historique des renouvellements. Le taux d’observa...
Background Medications already available to treat other conditions are presently being studied in... more Background Medications already available to treat other conditions are presently being studied in clinical trials as potential treatments for COVID-19. Given that pregnant women are excluded from these trials, we aimed to investigate their safety when used during pregnancy within a unique population source. Methods Using the population-based Quebec Pregnancy Cohort, we identified women who delivered a singleton liveborn (1998–2015). Taking potential confounders into account including indications for use, the risk of prematurity, low birth weight (LBW), small for gestational age (SGA), and major congenital malformation (MCM) associated with COVID-19 repurposed drug use during pregnancy were quantified using generalized estimation equations. Results Of the 231,075 eligible pregnancies, 107 were exposed to dexamethasone (0.05%), 31 to interferons (0.01%), 1,398 to heparins (0.60%), 24 to angiotensin-receptor blockers (ARB) (0.01%), 182 to chloroquine (0.08%), 103 to hydroxychloroquine ...
Women tend to discontinue their antidepressants during pregnancy. This study compared the risk of... more Women tend to discontinue their antidepressants during pregnancy. This study compared the risk of depressive symptoms in the second-half of pregnancy in women who discontinue or continue with or without dosage modification their antidepressant during gestation. Women were eligible if they called MothertoBaby during 2006-2010 and within 14 completed weeks of pregnancy. A total of 367 pregnant women were included. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depression during the first and second half of pregnancy. Presence of depressive symptoms was defined as EPDS ≥13. Among participants, 149 did not use antidepressants, 38 used antidepressants at the beginning of pregnancy but discontinued before the end of second-trimester, and 180 used antidepressants continuously throughout pregnancy. Among continued users, 46 modified antidepressant dosage before the end of the second trimester, and 134 did not modify dosage. The majority of antidepressant users (150/218, 68.8%) had mild to moderate depression. Thirteen percent (13%) of women who continued antidepressant use throughout pregnancy without dosage modification remained depressed. Adjusting for potential confounders including maternal depression/anxiety before pregnancy, and compared to non-users, discontinued users were 5.95 times (95%CI: 1.54-23.02), and continued users without dosage modification 4.59 times (95%CI: 1.44-14.64) more at risk of depression in the second-half of pregnancy. Those with dosage modifications were at a similar risk of depression during pregnancy than non-users (adjusted odds ratio 0.58, 95%CI: 0.06-5.52). In conclusion, in a cohort of mild to moderate depressive pregnant women, discontinuing or continuing antidepressant use without dosage modification during pregnancy were associated with an increased risk of depression during the remaining gestational period.
Purpose of Review Administrative claims databases, which collect reimbursement-related informatio... more Purpose of Review Administrative claims databases, which collect reimbursement-related information generated from healthcare encounters, are increasingly used to evaluate medication safety in pregnancy. We reviewed the strengths and limitations of claims-only databases and how other data sources may be used to improve the accuracy and completeness of information critical for studying medication safety in pregnancy. Recent Findings Research on medication safety in pregnancy requires information on pregnancy episodes, mother-infant linkage, medication exposure, gestational age, maternal and birth outcomes, confounding factors, and (in some studies) long-term follow-up data. Claims data reliably identifies live births and possibly other pregnancies. It allows mother-infant linkage and has prospectively collected prescription medication information. Its diagnosis and procedure information allows estimation of gestational age. It captures maternal medical conditions but generally has inc...
To describe biases in antimalarial randomized controlled trials (RCTs) during pregnancy and their... more To describe biases in antimalarial randomized controlled trials (RCTs) during pregnancy and their influence on antimalarial drug efficacy to reduce the risk of low birth weight (LBW). RCT characteristics and results were retrieved from a previous systematic review on the efficacy of antimalarials. The Cochrane risk of bias assessment was used to investigate source of biases in each RCT. The quality of RCT reporting published after the introduction of the CONSORT statement in medical literature in 1996 were compared to those published before 1996. A meta-regression analysis was performed to examine the impact of bias on the efficacy of antimalarials to reduce LBW after controlling for the time period prior to 1996. Twenty out of 25 RCTs (80%) had a high risk of bias. The proportion of RCTs having a low risk of bias was higher in manuscripts published after the introduction of CONSORT compared to those published before 1996 for sequence generation (P = 0.04) and allocation concealment...
American journal of obstetrics and gynecology, 2016
Smoking during pregnancy is a modifiable risk factor associated with adverse pregnancy outcomes. ... more Smoking during pregnancy is a modifiable risk factor associated with adverse pregnancy outcomes. Smoking during pregnancy has been shown to increase the risk of spontaneous abortion, prematurity, low birthweight, congenital malformations, and sudden infant death syndrome. Despite the fact that it is well known that smoking can lead to adverse pregnancy outcomes, 13-25% of pregnant women overall continue to smoke during this critical period. The objective of the study was to evaluate the effect of gestational use of bupropion and nicotine patch replacement therapy on the risk of the following: (1) smoking cessation, (2) prematurity, and (3) small for gestational age. Women included in the Quebec Pregnancy Cohort who filled the annual autoadministered questionnaire between Jan. 1, 1998, and June 30, 2009, were studied. Smokers before gestation with a pregnancy resulting in a live birth comprised the study population. Three mutually exclusive study groups were formed among those who sm...
British journal of clinical pharmacology, Jan 22, 2016
The use of selective serotonin reuptake inhibitors (SSRIs) in late pregnancy may be associated wi... more The use of selective serotonin reuptake inhibitors (SSRIs) in late pregnancy may be associated with an increased risk of persistent pulmonary hypertension of the newborn (PPHN). Limited data are available on the risk of PPHN associated with serotonin norepinephrine reuptake inhibitors (SNRIs). We aimed to quantify both associations. Using data from the Quebec Pregnancy Cohort between 1998 and 2009, we included women covered by the provincial drug plan who had a singleton live birth. Exposure categories were SSRI, SNRI and other antidepressant use; non-users were considered as the reference category. Generalized estimating equation models were used to obtain risk estimates and 95% confidence intervals (CIs). Confounding by indication was minimized by adjusting for history of maternal depression/anxiety before pregnancy. Overall, 143 281 pregnancies were included; PPHN was identified in 0.2% of newborns. Adjusting for maternal depression, and other potential confounders, SSRI use duri...
Perinatal psychological stress has been associated with unfavorable maternal and neonatal outcome... more Perinatal psychological stress has been associated with unfavorable maternal and neonatal outcomes. We aimed to assess the impact of perinatal stress on infant development at 1 year of age. We recruited pregnant women calling North American Teratogen Information Services or attending outpatient clinics at CHU Sainte Justine (Montreal) between 2008 and 2010 and their spouses. To be part of our study, women had to be (1) >18 years of age, (2) <15 weeks of gestational age at recruitment, (3) living within 250-km radius of Montreal, and (4) taking antidepressants or non-teratogenic drugs. Stress was assessed using the telephone-administered four-item perceived stress scale during pregnancy in mothers and at 2 months postpartum in both parents. Child development at 1 year of age was evaluated with the Bayley III scales. Socio-demographic and potential confounders were collected through telephone interviews. Multivariable linear regression models were built to assess the association between perinatal parental stress and child development. Overall, 71 couples and their infants were included. When adjusted for potential confounders, maternal prenatal stress was positively associated with motor development (adjusted β = 1.85, CI 95 % (0.01, 3.70)). Postpartum maternal and paternal stresses were negatively associated with motor and socio-emotional development, respectively (adjusted β = -1.54, CI 95 % (-3.07, -0.01) and adjusted β = -1.67, CI 95 % (-3.25, -0.10), respectively). Maternal and paternal postnatal stress seems to be harmful for the motor and socio-emotional development in 1-year-old children. No association was demonstrated between parental stress and cognitive, language, and adaptive behavioral development. However, prenatal maternal stress appears to improve motor skills.
Inappropriate consumption of anxiolytic, sedative and hypnotic medication (ASH) in the elderly is... more Inappropriate consumption of anxiolytic, sedative and hypnotic medication (ASH) in the elderly is an important public health issue. Almost 35 % of the elderly population living at home take these medications, approximately 206 days per year. According to Quebec data, people who are 65 and older take five times more ASH than people between 18 and 64. The use of ASH would not only be determined by the presence of symptoms, but also by psychosocial characteristics of the subjects. Moreover, several researchers have suggested that the family as well as the health system were environmental factors that could facilitate or inhibit consumption of these medications in the elderly. A conceptual framework is proposed to help specify more adequately the various explanatory hypotheses of this social health behavior and, consequently, better target interventions aiming at its modification.
Canadian Journal of Clinical Pharmacology, Oct 24, 2008
Information on healthcare costs associated with poorly treated psychiatric disorders during and a... more Information on healthcare costs associated with poorly treated psychiatric disorders during and after pregnancy is limited. To compare the direct healthcare costs, during and after pregnancy, between women who continue their antidepressant therapy during the whole gestational period and those who discontinue their treatment during the first trimester. Data from a 'Medications and Pregnancy' registry were used. Eligible women were 1) aged 15 - 45, 2) insured by the Quebec drug plan for > or =12 months prior to, during, and > or =3 months after pregnancy, 3) had > or =1 diagnoses of psychiatric disorders before pregnancy, 4) used antidepressants for . or =30 days in the year before pregnancy, and 5) had delivered. Women who continued their antidepressant therapy throughout pregnancy (Group 1) were compared to those who discontinued during the first trimester (Group 2). Healthcare costs, expressed as mean total costs and cost ratios, were determined during and after pr...
BACKGROUND Development of knowledge in understanding the use of anti-infective drugs during pregn... more BACKGROUND Development of knowledge in understanding the use of anti-infective drugs during pregnancy has been limited by difficulties in testing medications in pregnant women and lack of evidence-based data. Overuse of broad spectra agents is associated with development and spread of bacterial resistance, a problem that is faced as a significant threat to the public health. OBJECTIVES To describe trends in use of general and broad spectrum anti-infective drugs during pregnancy. METHODS We used the Quebec Pregnancy Registry to analyse trends for use of oral anti-infectives dispensed during pregnancy for the five-year period comprised between January 1998 and December 2002. Trends in use were assessed for classes of anti-infectives and for broad-spectrum drugs. Descriptive statistics were used to summarize the characteristics of the study population. Annual trends for the use of anti-infective drugs were analyzed using the Cochran-Armitage test. RESULTS The use of anti-infective drug...
Resume Objectif : Decrire et evaluer l’impact d’une intervention pharmaceutique sur l’observance ... more Resume Objectif : Decrire et evaluer l’impact d’une intervention pharmaceutique sur l’observance therapeutique de femmes enceintes atteintes du virus d’immunodeficience humaine sous traitement antiretroviral. Methodologie : Etude pilote portant sur des femmes enceintes atteintes du virus d’immunodeficience humaine, suivies a la clinique externe du Centre hospitalier universitaire Sainte-Justine de novembre 2004 a mai 2005. Lors du suivi mensuel, deux interventions du pharmacien avaient ete planifiees, a deux mois d’intervalle. L’observance a ete mesuree a l’aide de trois outils : un questionnaire, le decompte des comprimes et l’historique des renouvellements. Resultats : Le taux moyen de patientes observantes est passe de 75 % (n = 8) a 63 % (n = 8) selon le questionnaire, il est passe de 85 % (n =16 flacons de medicaments) a 97 % (n = 13 flacons de medicaments) selon le decompte des comprimes, alors qu’il est demeure inchange avec l’historique des renouvellements. Le taux d’observa...
Background Medications already available to treat other conditions are presently being studied in... more Background Medications already available to treat other conditions are presently being studied in clinical trials as potential treatments for COVID-19. Given that pregnant women are excluded from these trials, we aimed to investigate their safety when used during pregnancy within a unique population source. Methods Using the population-based Quebec Pregnancy Cohort, we identified women who delivered a singleton liveborn (1998–2015). Taking potential confounders into account including indications for use, the risk of prematurity, low birth weight (LBW), small for gestational age (SGA), and major congenital malformation (MCM) associated with COVID-19 repurposed drug use during pregnancy were quantified using generalized estimation equations. Results Of the 231,075 eligible pregnancies, 107 were exposed to dexamethasone (0.05%), 31 to interferons (0.01%), 1,398 to heparins (0.60%), 24 to angiotensin-receptor blockers (ARB) (0.01%), 182 to chloroquine (0.08%), 103 to hydroxychloroquine ...
Women tend to discontinue their antidepressants during pregnancy. This study compared the risk of... more Women tend to discontinue their antidepressants during pregnancy. This study compared the risk of depressive symptoms in the second-half of pregnancy in women who discontinue or continue with or without dosage modification their antidepressant during gestation. Women were eligible if they called MothertoBaby during 2006-2010 and within 14 completed weeks of pregnancy. A total of 367 pregnant women were included. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depression during the first and second half of pregnancy. Presence of depressive symptoms was defined as EPDS ≥13. Among participants, 149 did not use antidepressants, 38 used antidepressants at the beginning of pregnancy but discontinued before the end of second-trimester, and 180 used antidepressants continuously throughout pregnancy. Among continued users, 46 modified antidepressant dosage before the end of the second trimester, and 134 did not modify dosage. The majority of antidepressant users (150/218, 68.8%) had mild to moderate depression. Thirteen percent (13%) of women who continued antidepressant use throughout pregnancy without dosage modification remained depressed. Adjusting for potential confounders including maternal depression/anxiety before pregnancy, and compared to non-users, discontinued users were 5.95 times (95%CI: 1.54-23.02), and continued users without dosage modification 4.59 times (95%CI: 1.44-14.64) more at risk of depression in the second-half of pregnancy. Those with dosage modifications were at a similar risk of depression during pregnancy than non-users (adjusted odds ratio 0.58, 95%CI: 0.06-5.52). In conclusion, in a cohort of mild to moderate depressive pregnant women, discontinuing or continuing antidepressant use without dosage modification during pregnancy were associated with an increased risk of depression during the remaining gestational period.
Purpose of Review Administrative claims databases, which collect reimbursement-related informatio... more Purpose of Review Administrative claims databases, which collect reimbursement-related information generated from healthcare encounters, are increasingly used to evaluate medication safety in pregnancy. We reviewed the strengths and limitations of claims-only databases and how other data sources may be used to improve the accuracy and completeness of information critical for studying medication safety in pregnancy. Recent Findings Research on medication safety in pregnancy requires information on pregnancy episodes, mother-infant linkage, medication exposure, gestational age, maternal and birth outcomes, confounding factors, and (in some studies) long-term follow-up data. Claims data reliably identifies live births and possibly other pregnancies. It allows mother-infant linkage and has prospectively collected prescription medication information. Its diagnosis and procedure information allows estimation of gestational age. It captures maternal medical conditions but generally has inc...
To describe biases in antimalarial randomized controlled trials (RCTs) during pregnancy and their... more To describe biases in antimalarial randomized controlled trials (RCTs) during pregnancy and their influence on antimalarial drug efficacy to reduce the risk of low birth weight (LBW). RCT characteristics and results were retrieved from a previous systematic review on the efficacy of antimalarials. The Cochrane risk of bias assessment was used to investigate source of biases in each RCT. The quality of RCT reporting published after the introduction of the CONSORT statement in medical literature in 1996 were compared to those published before 1996. A meta-regression analysis was performed to examine the impact of bias on the efficacy of antimalarials to reduce LBW after controlling for the time period prior to 1996. Twenty out of 25 RCTs (80%) had a high risk of bias. The proportion of RCTs having a low risk of bias was higher in manuscripts published after the introduction of CONSORT compared to those published before 1996 for sequence generation (P = 0.04) and allocation concealment...
American journal of obstetrics and gynecology, 2016
Smoking during pregnancy is a modifiable risk factor associated with adverse pregnancy outcomes. ... more Smoking during pregnancy is a modifiable risk factor associated with adverse pregnancy outcomes. Smoking during pregnancy has been shown to increase the risk of spontaneous abortion, prematurity, low birthweight, congenital malformations, and sudden infant death syndrome. Despite the fact that it is well known that smoking can lead to adverse pregnancy outcomes, 13-25% of pregnant women overall continue to smoke during this critical period. The objective of the study was to evaluate the effect of gestational use of bupropion and nicotine patch replacement therapy on the risk of the following: (1) smoking cessation, (2) prematurity, and (3) small for gestational age. Women included in the Quebec Pregnancy Cohort who filled the annual autoadministered questionnaire between Jan. 1, 1998, and June 30, 2009, were studied. Smokers before gestation with a pregnancy resulting in a live birth comprised the study population. Three mutually exclusive study groups were formed among those who sm...
British journal of clinical pharmacology, Jan 22, 2016
The use of selective serotonin reuptake inhibitors (SSRIs) in late pregnancy may be associated wi... more The use of selective serotonin reuptake inhibitors (SSRIs) in late pregnancy may be associated with an increased risk of persistent pulmonary hypertension of the newborn (PPHN). Limited data are available on the risk of PPHN associated with serotonin norepinephrine reuptake inhibitors (SNRIs). We aimed to quantify both associations. Using data from the Quebec Pregnancy Cohort between 1998 and 2009, we included women covered by the provincial drug plan who had a singleton live birth. Exposure categories were SSRI, SNRI and other antidepressant use; non-users were considered as the reference category. Generalized estimating equation models were used to obtain risk estimates and 95% confidence intervals (CIs). Confounding by indication was minimized by adjusting for history of maternal depression/anxiety before pregnancy. Overall, 143 281 pregnancies were included; PPHN was identified in 0.2% of newborns. Adjusting for maternal depression, and other potential confounders, SSRI use duri...
Perinatal psychological stress has been associated with unfavorable maternal and neonatal outcome... more Perinatal psychological stress has been associated with unfavorable maternal and neonatal outcomes. We aimed to assess the impact of perinatal stress on infant development at 1 year of age. We recruited pregnant women calling North American Teratogen Information Services or attending outpatient clinics at CHU Sainte Justine (Montreal) between 2008 and 2010 and their spouses. To be part of our study, women had to be (1) >18 years of age, (2) <15 weeks of gestational age at recruitment, (3) living within 250-km radius of Montreal, and (4) taking antidepressants or non-teratogenic drugs. Stress was assessed using the telephone-administered four-item perceived stress scale during pregnancy in mothers and at 2 months postpartum in both parents. Child development at 1 year of age was evaluated with the Bayley III scales. Socio-demographic and potential confounders were collected through telephone interviews. Multivariable linear regression models were built to assess the association between perinatal parental stress and child development. Overall, 71 couples and their infants were included. When adjusted for potential confounders, maternal prenatal stress was positively associated with motor development (adjusted β = 1.85, CI 95 % (0.01, 3.70)). Postpartum maternal and paternal stresses were negatively associated with motor and socio-emotional development, respectively (adjusted β = -1.54, CI 95 % (-3.07, -0.01) and adjusted β = -1.67, CI 95 % (-3.25, -0.10), respectively). Maternal and paternal postnatal stress seems to be harmful for the motor and socio-emotional development in 1-year-old children. No association was demonstrated between parental stress and cognitive, language, and adaptive behavioral development. However, prenatal maternal stress appears to improve motor skills.
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