Trends in anti-infective use during pregnancy in France between 2010 and
2019: A nationwide population-based study.
Aim. To describe the trends in anti-infective use during pregnancy
between 2010 and 2019 and determine whether they were prescribed
according to drug fetal safety international classification systems.
Methods. We conducted a population-based, nationwide study using the
French national health data system including all pregnancies ended
between 2010 and 2019. Anti-infective were considered according to their
pharmacological group and potential harmful risk using the Australian
and Swedish classification systems. Prevalence rate was estimated
annually and by trimester. Average annual percent change (AAPC) and 95%
confidence intervals (CI) were calculated using Joinpoint regression.
Results. Among 7,571,035 pregnancies, 3,027,031 (40.0%) received ≥ 1
antibacterial. This proportion decreased significantly from 41.5% in
2010 to 36.1% in 2019 (AAPC=-1.7%, [95%CI, -2.5% to -1.0%]).
Conversely, use of antiviral agents increased during the 10 years’ study
period for anti-HSV agents (AAPC=4.4%, [3.7%-5.2%]), influenza
agents (AAPC=25.4%, [6.2%-48.1%]), and for HIV-antiretroviral
agents (HIV-ART) (AAPC=1.3%, [0.6%-2.0%]). Use of influenza
vaccine increased from 0.2% in 2010 to 4.2% in 2019 (AAPC=49.7%,
[95%CI, 39.3% to 60.9%]). Among all pregnancies, 0.9% had been
exposed to a potentially harmful anti-infective agent increasing from
0.7% in 2010 to 1.2% in 2019 (AAPC=6.4%, [4.4%-8.5 %]).
Conclusion. Based on more than 7 million pregnancies identified from
French nationwide data, this study showed that antibacterials are
frequently prescribed during pregnancy although their use has decreased
over the past ten years. Our results suggest that anti-infective are
generally prescribed in accordance with recommendations, with however a
potential for improvement in influenza vaccination.