{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T06:43:47Z","timestamp":1786171427227,"version":"build-2736575974"},"reference-count":34,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP1159536"],"award-info":[{"award-number":["APP1159536"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Nausea and vomiting in pregnancy is highly prevalent and can significantly impact pregnant women's quality of life. Despite this, access to effective pharmacotherapies can be constrained by stringent regulatory controls and socioeconomic barriers. The objective of this study was to examine the socioeconomic distribution of antiemetics (metoclopramide, ondansetron, and prochlorperazine) dispensed to pregnant women through Australia's publicly subsidized Pharmaceutical Benefits Scheme.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>We used the Maternity1000 linked administrative dataset to characterize antiemetics dispensed during 297\u2009630 pregnancies in Queensland, Australia (July 2013 to June 2018). Using a population\u2010based historical cohort study design, we analyzed dispensing volume, prevalence, and government expenditure across socioeconomic quintiles, with socioeconomic disadvantage defined using the Australian Bureau of Statistics' Index of Relative Socioeconomic Disadvantage. Inequalities in medication access and public expenditure were assessed using concentration indices (C) and concentration curves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Off\u2010label ondansetron dispensings for nausea and vomiting in pregnancy (i.e., use outside Therapeutic Goods Administration\u2010approved indications and not subsidized under the Pharmaceutical Benefits Scheme) accounted for the largest share of public expenditure (53.5%), followed by metoclopramide (45.2%) and prochlorperazine (1.3%). Across all three antiemetics, prevalence was highest among women in the most socioeconomically disadvantaged quintiles and declined progressively across the two least disadvantaged groups. Small pro\u2010poor inequalities in access (C\u2009&lt;\u2009\u22120.10) and moderate pro\u2010poor inequalities in public expenditure (C\u2009&gt;\u2009\u22120.25) were observed across all antiemetics. (Medication access: C\n                      <jats:sub>metoclopramide<\/jats:sub>\n                      \u2009=\u2009\u22120.07, 95% CI (\u22120.080 to \u22120.068); C\n                      <jats:sub>ondansetron<\/jats:sub>\n                      \u2009=\u2009\u22120.09, 95% CI (\u22120.114 to \u22120.075); C\n                      <jats:sub>prochlorperazine<\/jats:sub>\n                      \u2009=\u2009\u22120.08, 95% CI (\u22120.109 to \u22120.045). Government expenditure: C\n                      <jats:sub>metoclopramide<\/jats:sub>\n                      \u2009=\u2009\u22120.30, 95% CI (\u22120.316 to \u22120.285); C\n                      <jats:sub>ondansetron<\/jats:sub>\n                      \u2009=\u2009\u22120.25, 95% CI (\u22120.297 to \u22120.198); C\n                      <jats:sub>prochlorperazine<\/jats:sub>\n                      \u2009=\u2009\u22120.28, 95% CI (\u22120.350 to \u22120.205)).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Off\u2010label ondansetron access accounted for the majority of public expenditure on antiemetics dispensed during pregnancy, revealing a disconnect between health policy, clinical practice, public expenditure, and pregnant women's needs. While pro\u2010poor access and public subsidies for antiemetics align with the equity elements embedded in the design of the Pharmaceutical Benefits Scheme, they may also be reflective of inequitable access to other unsubsidized, guideline\u2010recommended pharmacotherapies for nausea and vomiting in pregnancy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70283","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T04:59:23Z","timestamp":1781240363000},"page":"1789-1799","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pharmaceutical policy and off\u2010label prescribing in pregnancy: A population\u2010based historical cohort study analyzing inequality in access to antiemetics within Australia's Pharmaceutical Benefits Scheme"],"prefix":"10.1111","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9788-8821","authenticated-orcid":false,"given":"Hannah","family":"Jackson","sequence":"first","affiliation":[{"name":"Faculty of Health, School of Public Health University of Technology Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8554-4696","authenticated-orcid":false,"given":"Luke","family":"Grzeskowiak","sequence":"additional","affiliation":[{"name":"College of Medicine and Public Health Flinders University  Adelaide South Australia Australia"},{"name":"SAHMRI Women and Kids, South Australian Health and Medical Research Institute  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4480-5690","authenticated-orcid":false,"given":"Joanne","family":"Enticott","sequence":"additional","affiliation":[{"name":"Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences Monash University  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3513-3471","authenticated-orcid":false,"given":"Sarah","family":"Wise","sequence":"additional","affiliation":[{"name":"Faculty of Health, School of Public Health University of Technology Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7233-6804","authenticated-orcid":false,"given":"Emily","family":"Callander","sequence":"additional","affiliation":[{"name":"Faculty of Health, School of Public Health University of Technology Sydney  Sydney New South Wales Australia"},{"name":"Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences Monash University  Clayton Victoria 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