Variation in clinical practice guideline recommendations for medication use in pregnancy in Australia: A systematic review

Hayley T Cron; Peter Simm; Joanne M Said; Jeanie L Y Cheong; Noel Cranswick; Yanhong Jessika Hu

doi:10.1111/ajo.13784

Variation in clinical practice guideline recommendations for medication use in pregnancy in Australia: A systematic review

Aust N Z J Obstet Gynaecol. 2023 Dec 17. doi: 10.1111/ajo.13784. Online ahead of print.

Authors

Hayley T Cron¹, Peter Simm^{1

2

3}, Joanne M Said^{4

5}, Jeanie L Y Cheong^{1

2

4

6}, Noel Cranswick^{1

2

7

8}, Yanhong Jessika Hu^{1

2}

Affiliations

¹ Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.
² Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
³ Department of Endocrinology, The Royal Children's Hospital, Melbourne, Victoria, Australia.
⁴ Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia.
⁵ Department of Maternal Fetal Medicine, Joan Kirner Women's & Children's at Sunshine Hospital, Western Health, Melbourne, Victoria, Australia.
⁶ Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia.
⁷ Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.
⁸ Clinical Pharmacology, The Royal Children's Hospital, Melbourne, Victoria, Australia.

PMID: 38105469
DOI: 10.1111/ajo.13784

Abstract

Background: Medication use in pregnancy is common; however, it is unknown if clinical practice guideline (CPG) prescribing recommendations referred to in Australia at the state, national and international level are consistent.

Aims: This systematic review aimed to: (1) identify sources of CPGs that inform prescribing during pregnancy in Australia; (2) assess CPG quality; and (3) evaluate variation within CPG recommendations for medication use in three common conditions in pregnancy: prophylactic antibiotics following premature rupture of membranes (PROM) at term, antidepressants in pregnancy and metformin in gestational diabetes mellitus (GDM).

Materials and methods: A literature search was conducted across PubMed, Scopus and EMBASE databases. Grey literature was identified through publicly available Australian policy statements. Prescribing recommendations for prophylactic antibiotics following PROM at term, antidepressants in pregnancy and metformin in GDM, were compared at the state, national and international levels. CPG quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.

Results: We identified 39 CPG sources that inform prescribing during pregnancy in Australia. CPG quality varied between resources. There was minor variation in recommendations for antibiotic prophylaxis in PROM at term. Recommendations regarding metformin use in GDM were also variable, with CPGs either recommending its use as a first-line agent when lifestyle modifications are not effective or when insulin therapy is not practicable. Recommendations for antidepressant use were consistent across CPGs analysed.

Conclusion: Multiple CPGs exist to inform prescribing during pregnancy in Australia, with variation present within CPG quality and recommendations. These findings offer insight into potential sources of variation in maternal and neonatal health outcomes.

Keywords: Australia; clinical practice guideline; medication; neonatal health; pregnancy.

© 2023 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Publication types

Review