Utilization of pharmacological treatment for alcohol use disorder in pregnancy in the total Swedish population
Background
Alcohol is a known teratogen and prenatal exposure to alcohol is associated with adverse child outcomes, such as preterm birth, low birth weight and fetal alcohol spectrum disorder. Globally, every tenth pregnant individual uses alcohol. In Europe 25% of pregnant people report alcohol use. Those who continue to use alcohol during pregnancy are likely to have an alcohol use disorder (AUD). There are evidence-based treatments for AUD – both psychological and pharmacological. There is, however, limited knowledge on the use of AUD pharmacotherapy in pregnancy.
The aim of this project is to study the utilization of pharmacological treatment for AUD before and during pregnancy, and after birth.
Methods
Longitudinal cohort study using data from a register-linkage research database including the total population in Sweden. Data on pregnancies in relation to pharmacotherapy for AUD was available year 2005 to 2011.
Population: Adults aged 18 and above, who 12 months before conception or during pregnancy received either an ICD-10 code of AUD, according to the National Patient Register, or filled a prescription of AUD pharmacotherapy according to the Prescribed Drug Register. Data on pregnancy was based on the National Medical Birth Register.
Outcome: Any filled prescription of AUD pharmacological treatment (Acamprosate, Disulfuram, Naltrexone or Nalmefene).
Covariates: Age was provided from Register of the Total Population. Education and income were obtained from the Longitudinal Integrated database for health insurance and labour market. Psychiatric co-morbidity was based on the National Patient Register. Utilization of other psychotropic drugs was based on the Prescribed Drug Register. Data on smoking was retrieved from the National Medical Birth Register.
Analyses: Descriptive analyses were performed, and logistic regressions are planned.
Results
We identified 889 pregnant adults who met inclusion criteria. Mean age at conception was 26 (range 18 – 50). Psychiatric comorbidities were prevalent, 56 % received a psychiatric diagnosis before or during pregnancy. 62 % utilize other psychotropic drugs and 44 % reported smoking.
The year before pregnancy, n=239, filled a prescription of AUD pharmacotherapy. During pregnancy, n=48 filled an AUD prescription, the majority during the first trimester. The year after birth, n=30 filled an AUD prescription.
Disulfiram was the most common pharmacotherapy before pregnancy (X2 (2) = 67.75, p = .00) and after birth (X2 (2) = 28.73, p = .00). During pregnancy, there were no differences in the utilization of Acamprosate, Disulfiram and Naltrexone (X2 (2) = 0.41, p = .82).
We aim to present the full results from the project at the conference.
Conclusion
The utilization of AUD pharmacotherapy during pregnancy in Sweden is low, especially during the second and third trimester. Very few individuals receive AUD pharmacotherapy the year after birth.
