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Fundam Clin Pharmacol. 2019 Oct;33(5):581-588. doi: 10.1111/fcp.12460. Epub 2019 Apr 1.

Non-steroidal anti-inflammatory drug prescriptions from the 6th month of pregnancy: impact of advice from health authorities.

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Centre Hospitalier Universitaire de Toulouse, Laboratoire de Pharmacologie Médicale et Clinique, INSERM, UMR 1027, Faculté de Médecine de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.
Protection Maternelle et Infantile, Conseil Général, 1 Boulevard de la Marquette, 31090, Toulouse, France.
Programme de Médicalisation des Systèmes d'Information, Centre Hospitalier Universitaire de Toulouse, Hôtel-Dieu Saint-Jacques, 2 Rue Charles Viguerie, 31059, Toulouse, France.
Centres Pluridisciplinaires de Diagnostic Prénatal, Centre Hospitalier Universitaire de Toulouse, Hôpital Paule de Viguier, 330 avenue de Grande Bretagne - TSA, 70034 - 31059, Toulouse, France.
Caisse Primaire d'Assurance Maladie de Haute-Garonne, 3 Boulevard du Professeur Léopold Escande, 31093, Toulouse, France.


Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used drugs. On June 2008 and February 2009, Dear Doctor Letters (DDLs) were sent by the French Health Authorities (AFSSAPS) to remind practitioners of risks with NSAIDs after the fifth month of pregnancy. The aim of this study was to evaluate the impact of these letters on NSAID prescriptions during late pregnancy. EFEMERIS is a French database that registers drugs prescribed and reimbursed during pregnancy and outcomes between 2004 and 2015. We performed a descriptive study and a 'before-and-after' comparison of NSAID prescriptions between 3 June 2006 and 3 June 2008 ('before group'), and between 1 March 2010 and 1 March 2012 ('after group'). We carried out a Cochran Armitage trend test to check whether the rate of women exposed to NSAIDs varies linearly over time. We identified 948 (4.38%) pregnant women in the 'before group' and 678 (2.73%) in the 'after group' receiving at least one NSAID prescription in late pregnancy (P < 0.0001). Between 2006 and 2012, mainly prescriptions for morniflumate/niflumic acid (1.7% vs. 0.9%; P < 0.0001), ibuprofen (0.8% vs. 0.6%; P = 0.01) and ketoprofen (0.7% vs. 0.3%; P < 0.0001) fell significantly after DDLs. The Cochran Armitage trend test shows that the percentage of women exposed to NSAIDs in late pregnancy decreased significantly during the study period (P < 0.0001). This study highlighted a significant decrease in the percentage of women receiving NSAID prescriptions during late pregnancy after DDLs. This decrease is not linked to a specific women's profile or prescriber's medical discipline.


database; drug prescriptions; non-steroidal anti-inflammatory drug; pregnancy; recommendations


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