Main Article Content

Anick Bérard
Anaïs Lacasse


Database, drug insurance, pharmacoepidemiology, pregnancy, Régie de l’assurance maladie du Québec, validity



The RAMQ prescription claims database (RAMQ-Rx) is increasingly being used in perinatal pharmacoepidemiologic studies; but, there are reasons to believe that results generated with the RAMQRx might not be generalizable to all patient populations.



Compare characteristics between pregnant women insured by the RAMQ-Rx and those insured by a private drug insurance plan.



A prospective study performed within the population of pregnant women receiving prenatal care at different obstetrics and gynecology clinics affiliated to the University of Montreal, Canada, was conducted from October 2004 to March 2006. Women were eligible if they were ?18 years of age, ?16 weeks of gestation at the time of their first prenatal visit, and able to read and understand French or English. Eligible women were asked to fill out a self-administered questionnaire.



Three hundred and sixty-three women met inclusion criteria, of which 99 (27%) had RAMQ-Rx coverage, and 264 (73%) had a private drug insurance coverage. Compared to those who were covered by private drug insurance plans, those insured by the RAMQ-Rx were younger (30.7yrs vs. 32.1yrs; P=0.03), more likely to be immigrant (60% vs. 24%; P<0.01), and have a household income below poverty level (39% vs. 2%; P<0.01). They were also less likely to be Caucasian (69% vs. 86%; P<0.01), employed (51% vs. 87%; P<.01), and have a post-secondary education (76% vs. 95%; P<0.01). No differences were observed on smoking status and alcohol use during pregnancy.



There are substantial differences between pregnant women insured by the RAMQ-Rx and those insured by private drug insurance plans. However, these differences will most likely limit generalizability, but not internal validity, of studies using data from the RAMQ-Rx database.

Abstract 210 | PDF Downloads 110


1. Tamblyn R, Lavoie G, Petrella L, Monette J. The use of prescription claims databases in pharmacoepidemiological research: the accuracy and comprehensiveness of the prescription claims database in Quebec. J Clin Epidemiol 1995;48:999-1009.
2. Abrishamchian AR, Khoury MJ, Calle EE. The contribution of maternal epilepsy and its treatment to the etiology of oral clefts: a population based case-control study. Genet Epidemiol 1994;11:343-51.
3. Ko DT, Mamdani M, Alter DA. Lipid-lowering therapy with statins in high-risk elderly patients: the treatment-risk paradox. JAMA 2004;291:1864-70.
4. Hackam DG, Thiruchelvam D, Redelmeier DA. Angiotensin-converting enzyme inhibitors and aortic rupture: a population-based case-control study. Lancet 2006;368: 659-65.
5. Aylin P, Bottle A, Majeed A. Use of administrative data or clinical databases as predictors of risk of death in hospital: comparison of models. BMJ 2007;334:1044.
6. Tricco AC, Pham B, Rawson NS. Manitoba and Saskatchewan administrative health care utilization databases are used differently to answer epidemiologic research questions. J Clin Epidemiol 2008;61:192-97.
7. Griffin MR, Stein CM, Graham DJ, Daugherty JR, Arbogast PG, Ray WA. High frequency of use of rofecoxib at greater than recommended doses: cause for concern. Pharmacoepidemiol Drug Saf 2004;13:339-43.
8. Demissie K, Breckenridge MB, Rhoads GG. Infant and maternal outcomes in the pregnancies of asthmatic women. Am J Respir Crit Care Med 1998;158:1091-95.
9. Rosa FW. Spina bifida in infants of women treated with carbamazepine during pregnancy. NEJM 1991;324:674-77.
10. Schade R, Andersohn F, Suissa S, Haverkamp W, Garbe E. Dopamine agonists and the risk of cardiac-valve regurgitation. NEJM 2007;356:29- 38.
11. Spitzer WO, Suissa S, Ernst P, et al. The use of beta-agonists and the risk of death and near death from asthma. NEJM 1992;326:501-06.
12. Strom BL. Data validity issues in using claims data. Pharmacoepidemiol Drug Saf 2001;10:389-92.
13. Régie de l'assurance maladie du Québec. Statistiques Annuelles 2002. 2003. Gouvernement du Québec.
14. Institut de la statistique du Québec. La situation démographique au Québec. Bilan 2006. 2006. Gouvernement du Québec.
15. James C, Thomas M, Lillie-Blanton M, Garfield R. Key Facts: Race, Ethnicity & Medical Care. Henry J. Kaiser Family Foundation. 02.pdf. 2007. 2-2-0080.
16. Fronstin P. Sources of health insurance and characteristics of the uninsured: analysis of the March 2007 Current Population Survey. EBRI Issue Brief 2007;1-33.
17. Lesser IM, Leuchter AF, Trivedi MH, et al. Characteristics of insured and noninsured outpatients with depression in STAR(*)D. Psychiatr Serv 2005;56:995-1004.
18. Wells KB, Sherbourne CD, Sturm R, Young AS, Burnam MA. Alcohol, drug abuse, and mental health care for uninsured and insured adults. Health Serv Res 2002;37: 1055-66.
19. Melfi CA, Croghan TW, Hanna MP. Access to treatment for depression in a Medicaid population. J Health Care Poor Underserved 1999;10:201-15.
20. Lacasse A, Rey E, Ferreira E, Morin C, Berard A. Validity of a modified Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scoring index to assess severity of nausea and vomiting of pregnancy. Am J Obstet Gynecol 2008;198:71.
21. Lacasse A, Berard A. Validation of the nausea and vomiting of pregnancy specific health related quality of life questionnaire. Health Qual Life Outcomes 2008;6:32.
22. Lacasse A, Rey E, Ferreira E, Morin C, Berard A. Nausea and vomiting of pregnancy: what about quality of life? BJOG 2008;115:1484-93.
23. Fronstin P. Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2006 Current Population Survey. Employee Benefit Research Institute. -20061.pdf October 2006, EBRI Issue Brief #298. 2006. 2-2-0080.
24. Polygenis D, Wharton S, Malmberg C, et al. Moderate alcohol consumption during pregnancy and the incidence of fetal malformations: a meta-analysis. Neurotoxicol Teratol 1998;20:61-67.
25. Tenkku EL, Morris DS, Mengel MB. Disparities in Risk or an Alcohol Exposed Pregnancy in a Sample of Urban Women. J FAS International 2007;5:e4.
26. Harlap S, Shiono PH. Alcohol, smoking, and incidence of spontaneous abortions in the first and second trimester. Lancet 1980;2:173-76.
27. Roman H, Robillard PY, Verspyck E, Hulsey TC, Marpeau L, Barau G. Obstetric and neonatal outcomes in grand multiparity. Obstet Gynecol 2004;103:1294-99.
28. Rawson NS, D'Arcy C. Assessing the validity of diagnostic information in administrative health care utilization data: experience in Saskatchewan. Pharmacoepidemiol Drug Saf 1998;7:389-98.
29. Carson JL, Strom BL. Medicaid databases. In: Strom BL, editor. Pharmacoepidemiology. Chichester:Wiley, 1994.