(AB) National Trends and Utilization Patterns of Benzodiazepines and Z-Hypnotics Among 2,883,162 Pregnant Women in Taiwan: An Interrupted Time Series Analysis

Publication Number: 1026

Background: Among pregnant women with anxiety or sleep disorders, benzodiazepines (BZDs) and z-hypnotics (such as zolpidem) may be prescribed. The use of BZDs/z-hypnotics during pregnancy has been associated with adverse perinatal outcomes. However, little is known about the utilization pattern of these drugs among pregnant women.

Objectives: The first part of the study aimed to assess the secular trends of BZDs/z-hypnotics use among pregnant women between 2004 and 2018 from a nationwide perspective. In the second part of the study, we aimed to evaluate the use of BZDs/z-hypnotics before, during, and after pregnancy by adopting interrupted time series analysis (ITSA) for individual pregnant women.

Methods: A nationwide cohort study was conducted using both National Birth Certificate Application (BCA) and National Health Insurance Research Database (NHIRD) in Taiwan. Singleton pregnancies with a gestational age of at least 20 weeks between 2004 and 2018 were included. National trends of BZDs/z-hypnotics use during pregnancy were estimated annually. The utilization patterns of BZDs/z-hypnotics (I) before pregnancy; (II) after 1st trimester; (III) after 2nd trimester; (IV) after 3rd trimester; and (V) after birth were assessed using ITSA, and segmented regression models were used to estimate the level and trend changes of BZDs/z-hypnotics uses across different stages of pregnancy.

Results: Overall, the prevalence of BZDs/z-hypnotics use among 2,883,162 pregnant women was 3.5% and remained stable from 2004 to 2018 (3.7% to 3.3%). However, BZDs/z-hypnotics uses varied across different stages of pregnancy. The ITSA revealed a sudden decrease of BZDs/z-hypnotics uses at 2 weeks after conception (level change -0.59%, 95% CI -0.64% to -0.55%; trend change -0.05, 95% CI -0.07 to -0.03). In contrast, the BZDs/z-hypnotics use increased remarkably after the delivery of these women (level change 0.12%, 95% CI 0.07% to 0.16%; trend change 0.04, 95% CI 0.03 to 0.06).

Conclusions: This is the first nationwide cohort study using ITSA to demonstrate the utilization patterns of BZDs and z-hypnotics during pregnancy. We found that BZDs/z-hypnotics uses varied across different stages of pregnancy, especially after conception and delivery. Special attention may be warranted for those who have childbirth considering the remarkable increases of BZDs/z-hypnotics uses after the delivery.