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臺灣懷孕婦女處方用藥分析─全民健保資料庫研究
廖慧伶 1,* 李怡君 2 何玉鈴 3 許俊正 4 洪一仁 1 張永勳 5
1
行政院衛生署豐原醫院藥劑科
2
中國醫藥大學公共衛生學院生物統計所
3
弘光科技大學護理學系
4
行政院衛生署臺北醫院婦產科
5
中國醫藥大學中國藥學研究所
摘 要
目的:本研究利用國家衛生研究院全民健康保險研究資料庫之大型樣本,探討臺灣懷孕婦女使用處方藥之平均
天數、處方藥品類別及其安全等級。
方法:採用健保資料庫 2005 年承保抽樣歸人檔,以 ICD-9-CM 診斷碼篩選出於 2005 至 2007 年懷孕個案納為
研究樣本,將其懷孕期間所有用藥,逐一進行藥理作用分類及安全級數編碼及統計。本研究之樣本納入原
則為懷孕診斷起始日之後 270 日內有生產診斷者。經篩選後共有 1,586 人次符合並納為研究樣本。
結果:經分析結果,懷孕期間之用藥類別,最多之前三名依序是「咳嗽及感冒製劑」(16.71%)、「解熱鎮痛劑」
(11.60%) 及「制酸劑,抗逆流製劑及抗潰瘍藥」(10.73%)。在懷孕用藥安全等級方面,以 B 級藥品最多(占
62.79%),其次為 C 級 (27.54%)、A 級 (7.29%)、D 級 (1.43%) 及 X 級 (0.95%)。
結論:臺灣婦女懷孕期間用藥以安全性較高的 B 級藥品居多,但有少數使用高危險之 D 級及 X 級藥品,為不可
忽視之用藥風險。
關鍵詞:全民健保資料庫,處方藥,懷孕
引言 國境內上市的藥品均須標示「懷孕用藥安全級
數」,此級數乃根據臨床試驗所得之結果,將藥
早於數十年前已經證實出生胎兒的先天
物對胎兒造成的危險性由低至高,分為 A 級、B
缺陷與母 體在懷孕 期間的用藥 有關 [1],史 上
級、C 級、D 級及X 級等五級,其代表意義分別為,
最受矚目的孕婦用藥導致胎兒畸型的沙利竇邁
A 級「明確的實驗證實對人類胎兒無害」
、B 級「對
(thalidomide) 事 件,於 1957 年 thalidomide 上市
動物胎兒無害,對人類胎兒的危險性未經證實」
、
時在動物實驗上被證實是安全藥品,於 1960 年
C 級「對動物胎兒確有不良影響,但對人類胎兒
代 thalidomide 廣泛用於治療 孕 婦的噁心 嘔吐
未有充分的研究證據」、D 級「對胎兒有危險性,
與 害 喜 症 狀,後 來 發 現 thalidomide 與 嚴 重 的
但對某些特定疾病之治療效益超過其危險性」、
畸胎形成有關,多數國家在 1961 年停用此藥。
X 級「已證實對動物或人類胎兒致畸形,危險性
之後,又發 現 孕 婦服 用治 療 高危 險 妊 娠 藥 物
高於治療效益」。
diethylstilbestrol,所生出的女嬰發生生殖系統異
有關藥品於懷孕期之安全性,僅限於動物
常及增加罹患細胞腺癌的風險 [2,3],再次引起醫
實驗,基於倫理考量,藥品上市前,藥廠少有針
療界對孕婦用藥安全之注意。
對孕婦進行人體試驗,故無法評估藥品對胎兒健
美國食品與藥物管理局 (FDA) 於 1980 年
康的影響,因此,除少數藥品具有足夠證據確定
制定藥物致畸胎作用的分類系統,並規定凡在美
Copyright©2013 by Center for Taiwan Society of Health-System Pharmacists & Airiti Press Inc. All rights reserved.
臺灣臨床藥學雜誌 第 21 卷第 2 期
臺灣臨床藥學雜誌 第 21 卷第 2 期
Table 3 Age distribution in the category D and X drugs that prescribed to pregnant women
Category D Category X
Age
Frequency Percentage (%) Frequency Percentage (%)
≤ 20 4 3.64 2 2.74
21 ~ 30 63 57.27 57 78.08
31 ~ 40 43 39.09 14 19.18
41 ~ 50 0 0.00 0 0.00
Total 110 100.00 73 100.00
臺灣臨床藥學雜誌 第 21 卷第 2 期
Table 4 Distribution of category D drugs prescribed for the common diagnostic groups during
pregnancy
Major disease category ICD-9-CM Frequency Percentage
code (%)
Diseases of the skin and subcutaneous tissue 680-709 27 16.36
Diseases of the nervous system and sense organs 320-389 20 12.12
Endocrine, nutritional and metabolic diseases, and immunity disorders 240-279 16 9.70
Diseases of the genitourinary system 580-629 13 7.88
Diseases of the respiratory system 460-519 13 7.88
Symptoms, signs, and ill-defined conditions 780-799 13 7.88
Mental disorders 290-319 12 7.27
Supplementary classification of factors influencing health status and V01-V86 12 7.27
contact with health services
Complications of pregnancy, childbirth, and the puerperium 630-677 11 6.67
Injury and poisoning 800-999 9 5.45
Infectious and parasitic diseases 001-139 9 5.45
Diseases of the circulatory system 390-459 7 4.24
Diseases of the musculoskeletal system and connective tissue 710-739 2 1.21
Diseases of the digestive system 520-579 1 0.61
Total 165 100.00
臺灣臨床藥學雜誌 第 21 卷第 2 期
Table 6 Distribution of category X drugs prescribed for the common diagnostic groups during
pregnancy
Major disease category ICD-9-CM Frequency Percentage
code (%)
Diseases of the genitourinary system 580-629 67 60.91
Diseases of the respiratory system 460-519 12 10.91
Symptoms, signs, and ill-defined conditions 780-799 10 9.09
Endocrine, nutritional and metabolic diseases, and immunity disorders 240-279 7 6.36
Mental disorders 290-319 5 4.55
Supplementary classification of factors influencing health status and V01-V86 5 4.55
contact with health services
Complications of pregnancy, childbirth, and the puerperium 630-677 2 1.82
Diseases of the nervous system and sense organs 320-389 1 0.91
Diseases of the skin and subcutaneous tissue 680-709 1 0.91
Total 110 100.00
臺灣臨床藥學雜誌 第 21 卷第 2 期
臺灣臨床藥學雜誌 第 21 卷第 2 期
臺灣臨床藥學雜誌 第 21 卷第 2 期
ABSTRACT
Objectives: This study used the massive samples of National Health Insurance Research Database (NHIRD)
to explore the average days pregnant women used prescribed medicine and the category and
safety level of the prescribed medicine they used during pregnancy.
Methods: A random sample was retrieved from Year 2005 NHIRD. A diagnosis code ICD-9-CM was used
to screen pregnancy cases from 2005 to 2007 as research samples and then the medicines used
by the selected samples during pregnancy were identified. The FDA pregnancy category was
used to sort out the safety level of each medicine and the medicines were coded. This study only
included the cases giving birth within 270 days from the first day of pregnancy. In total, there
were 1,586 valid samples.
Results: The analysis showed the three most commonly used medicines during pregnancy were Cough &
Cold Preparations (16.71%), Analgesics & Antipyretics (11.60%) and Antacids, Antireflux
Agents & Antiulcerants (10.73%). Furthermore, the analysis on the safety level of pregnancy
medicines showed Pregnancy Category B medicines were the most frequently used (62.79%),
Category C the second (27.54%), Category A the third (7.29%), Category D the fourth (1.43%)
and Category X the fifth (0.95%).
Conclusions: This study found that there was a “prenatal diagnosis” category coded “ICD-9-CM 640-677” in
the NHIRD. During pregnancy, the most commonly used medicines were Pregnancy Category
B medicines which were recognized as “probably safe.” However, a very few pregnant women
used highly risky Pregnancy Category D and Pregnancy Category X medicines, the high risk of
those drugs should not be ignored.
Key words: National Health Insurance Research Database, Prescription Drug, Pregnancy
*
Corresponding author: Hui-Ling Liao
DOI: 10.6168FJCP.2013.2102.05
臺灣臨床藥學雜誌 第 21 卷第 2 期