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Background/Objectives: Substance use during pregnancy is associated with adverse outcomes for both mother and child. This study aimed to determine the prevalence and determinants of alcohol, tobacco and illicit drug use before and during pregnancy in Belgium. Methods: An observational study was conducted using data from the longitudinal BELpREG registry. The study included women aged 18 years or older who completed at least one questionnaire on substance use during pregnancy between 2022 and 2024. Data were analyzed using descriptive statistics and logistic regressions. Results: In total, 1441 women were included. Preconception prevalences of alcohol, tobacco and illicit drug use were 82.2%, 10.0% and 4.2%. These self-reported prevalences dropped in the first trimester to 12.9%, 4.1% and 0.6%, respectively. Considering the rates of substance use in pregnancy but before pregnancy awareness, the overall prevalence of alcohol, tobacco and illicit drug use in the first trimester was 41.0%, 6.6% and 1.2%, respectively. Women with a higher education (aOR (adjusted odds ratio), 2.12; 95% CI (confidence interval): 1.14–3.96), unplanned pregnancies (aOR, 2.88; 95% CI: 1.77–4.67), spontaneous pregnancies (aOR, 2.94; 95% CI: 1.51–5.75), cohabitants drinking alcohol daily (aOR, 2.01; 95% CI: 1.09–3.70), and those using tobacco in the first trimester (aOR, 5.37; 95% CI: 2.70–10.66) were more likely to report alcohol use. In addition, women with a lower education (aOR, 7.67; 95% CI: 3.76–15.67), unplanned pregnancies (aOR, 3.31; 95% CI: 1.53–7.15), cohabitants using tobacco (aOR, 9.11; 95% CI: 4.48–18.52), and those who used alcohol (aOR, 6.67; 95% CI: 3.07–14.64) or illicit drugs (aOR, 39.03; 95% CI: 3.72–409.83) in the first trimester were more likely to report tobacco use. Conclusions: Despite a significant reduction in substance use in pregnancy compared to before pregnancy, a relevant portion of women continue to use substances, particularly in the early stages before pregnancy awareness. Targeted public health interventions and (more) awareness among caregivers are needed to further promote substance use cessation before conception. [ABSTRACT FROM AUTHOR]

Although medication use during pregnancy is common, most available products lack sufficient safety information. As prospective data collection and perinatal pharmacoepidemiologic research on medication safety in pregnancy did not exist in Belgium yet, the BELpREG data registration system was developed. BELpREG enables comprehensive "real-world" data collection on perinatal medication use and mother-infant outcomes via online questionnaires that are completed by pregnant women every 4 weeks during pregnancy and in the first 8 weeks after childbirth. This paper describes the development and current design of the BELpREG system, including the list of BELpREG variables. To compile this list of variables, relevant documents were explored, followed by consultation of an interdisciplinary expert panel. The included variables were structured in seven categories: 1) Sociodemographic characteristics; 2) Information on the current pregnancy and health status; 3) Maternal-obstetric history; 4) Use of medicines, folic acid/pregnancy vitamins and other health products; 5) Substance use; 6) Pregnancy outcomes; and 7) Neonatal outcomes. An electronic informed consent and linkage to medication databases, with images of drug packages and underlying structured data fields, are built into the system. Data collection has officially started in November 2022. Based on its rigorous design, BELpREG holds the potential to be a successful and sustainable research tool, enabling perinatal pharmacoepidemiologic research in Belgium and beyond. [ABSTRACT FROM AUTHOR]

Over the past decade, treatment options for relapsed/refractory multiple myeloma (RRMM) have increased substantially. To find the best therapy for each individual patient, patient preferences should be considered. Therefore, shared decision making (SDM) for RRMM treatments is key. The aim of this study was to explore perceptions of patients, caregivers and healthcare professionals (HCPs) on SDM for RRMM treatment and investigate current SDM practices. Exploratory qualitative study, including semi-structured interviews with 17 RRMM patients, 8 informal caregivers, and 19 HCPs (haematologists, nurses, onco-coaches, and hospital pharmacists). Participants were recruited in five Belgian hospitals between January and November 2020. An iterative inductive approach was used to analyze the findings. The concept of SDM seemed to be unknown to most patients and caregivers. Some overestimated their expected role in SDM, thinking it entails making decisions on their own; others saw their role in SDM limited to agreeing or disagreeing upon a treatment proposal. Misconceptions on SDM were also present among HCPs. All HCPs recognized the importance of involving patients in the decision-making process but seem to struggle with the operationalisation of SDM. Some HCPs felt they might burden patients with the task of involvement: they think it is too difficult for patients, and only consider to involve 'strong' patients. The interviews showed that most patients were not actively involved in the decision-making process. Mainly reactive and ad hoc behaviour occurs, driven by patients themselves. Decision making especially lacked the essential exploration of patients' needs and preferences. Based on the results, SDM still seems uncommon in RRMM clinical practice. Education of patients and HCPs is needed to make them familiar with the concept of SDM, dispel any misconceptions and help them to look beyond perceived barriers. Moreover, tools to support implementation of SDM practices could be helpful. [ABSTRACT FROM AUTHOR]