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Pregnancy EarlySafeStartNCT04182750

Promoting Safe Medication Use in Pregnancy in the Era of Real-World Data - The SafeStart Study

A study testing Pharmacist consultation in people with Pregnancy Early and Emesis, run by Hedvig Marie Egeland Nordeng at 1 site in Norway.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The background for this project is the growing concern about women's use of medications during pregnancy. Several studies have shown that up to 80% of all pregnant women use at least one medication during pregnancy, most commonly prescription-free medications for pregnancy-related ailments. Read more about this study

Who is it for?
Ages 18 years and older, women only
Conditions the study is for
Pregnancy Early, Emesis, Medication Adherence
What is being tested?
Pharmacist consultation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
369 participants
Where
1 siteNorway
Study dates
6 Feb 2018to 27 Nov 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Pregnant in the first trimester (< gestational week 12)
  • Speaks/understand Norwegian

Who cannot join

None listed.

Trial locations and contacts

1 site in 1 country.

Norway1 site
  • Department of Pharmacy, University of Oslo

    Oslo, 0371

Other trials in Norway

About this study

The background for this project is the growing concern about women's use of medications during pregnancy. Several studies have shown that up to 80% of all pregnant women use at least one medication during pregnancy, most commonly prescription-free medications for pregnancy-related ailments. Despite the frequent use of medications during pregnancy pregnant women tend to overestimate the teratogenic risk of medications - often resulting in unfound anxiety, non-adherence to needed medication, use of herbal "natural" medications, and in the worst case, termination of otherwise wanted pregnancies. Specifically, the investigators have found that ailments such as nausea and vomiting in pregnancy (NVP), often are mismanaged, resulting in profound impacts on the women´s quality of life, but are often being neglected by healthcare personnel.

The objective of this project is to investigate whether a pharmacist consultation provided in early pregnancy can result in optimized management of pregnancy-related ailment, a higher quality of life and reduce sick leave among pregnant women. The investigators will capitalize on the existence of a unique personal identification number allocated to every citizen in Norway and link the self-reported data generated in the intervention study to five national health registries. As even mild NVP has been shown to have a huge impact on pregnant women's quality of life, the investigators will specifically focus on preventative measures for NVP.

Read more

The investigators main hypothesis is:

"A pharmacist intervention focusing on safe medication use and in early pregnancy can reduce sick leave days and rates, enhance adherence, promote better management of common pregnancy-related ailments (especially NVP), and improve pregnant women's quality of life"

The investigators will include all pregnant women in pregnancy weeks <12. Pregnant women under the age of 18, women who do not understand Norwegian and women for some other reason are unable to sign the consent form will be excluded. Women eligible for inclusion will be allocated to either the intervention group or the control group. Participants in the intervention group will be directed to the nearest study pharmacy for the intervention. The proposed study intervention is to be applied and carried out in the community pharmacy. Approximately 10-15 community pharmacists across the country will be involved. If the distance to a study pharmacy is too far for a physical meeting, the intervention will be performed over the telephone; otherwise, the private information room in the pharmacies will be utilized.

All pharmacists involved in the study will be specifically trained to perform the consultation. They will complete several e-learning modules on pharmacotherapy in pregnancy and attend a full-day training work-shop focusing on communication skills led by experienced clinical pharmacists.

Data will be collected by four online questionnaires, one at baseline in the first trimester, one during the second trimester, one during the third trimester, and the last one in the post-partum period. Participants in the intervention group will, in addition, complete a satisfaction questionnaire right after the completion of the consultation. All questionnaires will be distributed to the participants by email. Data about the participants will, in addition, be collected from five national registries; National Sick Leave Database (Forløpsdatabasen Trygd), The Norwegian Patient Registry, The Norwegian Prescription Database, The Medical Birth Registry of Norway, and the Municipality Patient and User Registry (Kommunalt Bruker- og Pasientregister). These data will be linked to the self-reported data (by the unique identification number of every citizen in Norway) collected during the intervention study.

An economic evaluation will be done to assess the cost-effectiveness of the intervention.

All study pharmacists involved in the study will be invited to participate in a qualitative interview to share their experience and opinions regarding the pharmacist intervention.

Participants enrolled in the intervention study will be invited to a qualitative interview to share their inputs and opinions on what a mobile application for self-management and an online patient-centered decision support tool for NVP should include.

Being tested
Pharmacist consultation
Medical subject headings
Vomiting, Medication Adherence

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Pharmacist consultationOther

    The intervention is a patient-centered consultation that will last about 15 minutes. The intervention is defined as "A planned, individualized, and structured conversation with the purpose to relieve pregnant women for any concern and answer questions she may have regarding self-care ailments and medication use in pregnancy". Specifically, the consultation will:

    • Answer any questions the participants may have within pharmaceutical care.
    • Improve pregnant women's understanding of common pregnancy-related ailments and hence contribute to better management of the ailments.
    • Raise awareness, provide confidence, and give information about safe medications options in pregnancy
    • Focus on preventative measures for NVP.
    • Contribute to better adherence for needed/chronic medication throughout the pregnancy.

    The pharmacists will beforehand have access to the women´s answers from the baseline questionnaire Q1, including information about her medical conditions and medication use.

Study groups in NCT04182750
Study groupRoleWhat they receive
Intervention groupExperimentalPharmacist consultation in early pregnancy (gestation week <12)
Receives: Other: Pharmacist consultation
Control groupNo interventionStandard care.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in quality of life between the first and second trimester

    Quality of life measured by the Quality of Life Scale (QOLS) which ranges from 16 to 112, where higher score indicates better quality of life

    Measured: Change in quality of life between the first (gestation week < 12) and second trimester (between gestation week 17 and 25)

  2. Sick leave during the first trimester

    Self-reported sick leave rate and days and as recorded in the national registry (Forløpsdatabasen Trygd) during the first trimester (up to weeks 12)

    Measured: Up to weeks 12

  3. Sick leave during the second trimester

    Self-reported sick leave rate and days and as recorded in the national registry (Forløpsdatabasen Trygd) during the second trimester (between weeks 13 and 28)

    Measured: Between weeks 13 and 28

  4. Sick leave during the third trimester

    Self-reported sick leave rate and days and as recorded in the national registry (Forløpsdatabasen Trygd) during the third trimester (between weeks 19 and delivery)

    Measured: Between weeks 29 and delivery

  5. Sick leave in the post-partum period

    Self-reported sick leave rate and days and as recorded in the national registry (Forløpsdatabasen Trygd) from delivery and up to three months post-partum

    Measured: From delivery and up to three months post-partum

  6. Utilization of health care services during the first trimester

    Self-reported number of visits and as recorded in the Norwegian Patient Registry during the first trimester (up to weeks 12)

    Measured: Up to weeks 12

  7. Utilization of health care services during the second trimester

    Self-reported number of visits and as recorded in the Norwegian Patient Registry during the second trimester (between weeks 13 and 28)

    Measured: Between weeks 13 and 28

  8. Utilization of health care services during the third trimester

    Self-reported number of visits and as recorded in the Norwegian Patient Registry during the third trimester (between weeks 29 and delivery)

    Measured: Between weeks 29 and delivery

  9. Utilization of health care services in the post-partum period

    Self-reported number of visits and as recorded in the Norwegian Patient Registry from delivery and up to three months post-partum

    Measured: From delivery and up to three months post-partum.

  10. Use of medications during the first trimester

    Self-reported medication use and as recorded in the Norwegian Prescription Database during the first trimester (up to weeks 12)

    Measured: Up to weeks 12

  11. Use of medications during the second trimester

    Self-reported medication use and as recorded in the Norwegian Prescription Database during the second trimester (between weeks 13 and 28)

    Measured: Between weeks 13 and 28

  12. Use of medications during the third trimester

    Self-reported medication use and as recorded in the Norwegian Prescription Database during the third trimester (between weeks 29 and delivery)

    Measured: Between weeks 29 and delivery

  13. Use of medications in the post-partum period

    Self-reported medication use and as recorded in the Norwegian Prescription Database from delivery and up to three months post-partum

    Measured: From delivery and and up to three months post-partum.

  14. Quality-Adjusted-Life-Years (QALY) during the first trimester

    Participants' Quality-Adjusted-Life-Years (QALYs) measured by the EuroQoL health-related quality of life instrument (EQ-5D-5L) during the first trimester. The EQ-5D-5L state will be converted to an index value (based on the most appropriate weights available for the Norwegian population) and further to QALYs. QALYs ranges from 0 (death) to 1 (full or optimal health).

    Measured: Up to weeks 12

  15. Quality-Adjusted-Life-Years (QALY) during the second trimester

    Participants' Quality-Adjusted-Life-Years (QALY) measured by the EuroQoL health-related quality of life instrument (EQ-5D-5L) during the second trimester. The EQ-5D-5L state will be converted to an index value (based on the most appropriate weights available for the Norwegian population) and further to QALYs. QALYs ranges from 0 (death) to 1 (full or optimal health).

    Measured: Between weeks 13 and 28

  16. Quality-Adjusted-Life-Years (QALY) during the third trimester

    Participants' Quality-Adjusted-Life-Years (QALY) measured by the EuroQoL health-related quality of life instrument (EQ-5D-5L) during the third trimester. The EQ-5D-5L state will be converted to an index value (based on the most appropriate weights available for the Norwegian population) and further to QALYs. QALYs ranges from 0 (death) to 1 (full or optimal health).

    Measured: Between weeks 29 and delivery

  17. Quality-Adjusted-Life-Years (QALY) in the post-partum period

    Participants' Quality-Adjusted-Life-Years (QALY) measured by the EuroQoL health-related quality of life instrument (EQ-5D-5L) from delivery and up to three months post-partum. The EQ-5D-5L state will be converted to an index value (based on the most appropriate weights available for the Norwegian population) and further to QALYs. QALYs ranges from 0 (death) to 1 (full or optimal health).

    Measured: Between delivery and up to three months post-partum

  18. Economic evaluation of the intervention

    All costs related to performing the intervention, reported by the study pharmacists

    Measured: After intervention completion (up to weeks 12)

  19. Economic evaluation of the intervention

    Cost related to sick leave as recorded in the national registry Forløpsdatabasen Trygd during pregnancy and up to three months post-partum

    Measured: 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Dec 2019
  2. Study start6 Feb 2018
  3. Primary completion31 Oct 2021
  4. Study completion27 Nov 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
369 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04182750
Sponsor's protocol ID
SafeStart
Acronym
SafeStart
Status last verified
Nov 2023
First submitted
22 Nov 2019
Last updated
28 Nov 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: There is not a plan to make IPD available because of data protection regulation.

Publications

  • Ngo E, Truong MB, Nordeng H. Impact of a primary care pharmacist consultations on pregnant women's medication use: the SafeStart intervention study linked to a national prescription database. Int J Clin Pharm. 2023 Aug;45(4):893-902. doi: 10.1007/s11096-023-01577-x. Epub 2023 May 8.

    PubMed 37156960
  • Truong MB, Ngo E, Ariansen H, Tsuyuki RT, Nordeng H. The effect of a pharmacist consultation on pregnant women's quality of life with a special focus on nausea and vomiting: an intervention study. BMC Pregnancy Childbirth. 2020 Dec 9;20(1):766. doi: 10.1186/s12884-020-03472-z.

    PubMed 33298010

Questions about this trial

What is this clinical trial studying?

A study testing Pharmacist consultation in people with Pregnancy Early and Emesis, run by Hedvig Marie Egeland Nordeng at 1 site in Norway.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 0 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 28 Nov 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Norway. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in quality of life between the first and second trimester (time frame: Change in quality of life between the first (gestation week < 12) and second trimester (between gestation week 17 and 25)). The study lists 19 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04182750, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Nov 2023.

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