The ConcePTION project

The ConcePTION initiative was launched in April 2019, funded by the Innovative Medicines Initiative. The project aims to enhance knowledge about the effects of medications used during pregnancy and breastfeeding.

Graphic: There are 5,000,000 pregnancies each year in Europe. Up to 90 % take medication at some stage during their pregnancy or when breastfeeding. 71 % of available medicines include no information on use when pregnant. 83 % include no information on use when breastfeeding. 3.7 % of medicines are explicitly labelled as safe whilst many more are but lack the evidence. 1 in 3 choose to discontinue treatment, with potentially serious consequences to their health. 25 % experience anxiety due to a lack of information about medicines. 52 % encounter inconsistencies in the available information. 40 % report difficulty in understanding what is available. 20 % cannot find any relevant information at all

Contact

Researchers at PharmaSafe, University of Oslo are involved in several of the work packages. They are:

WP1: Using large health care data bases to study medication use and safety in pregnancy.

UIO researchers are involved in 5 unique multinational demonstration studies:

MedicationNOVELTY
GabapentionoidsWill provide solution for how we account for the underlying indication for medication use thus limiting the “disease bias” in future medications in pregnancy studies
AntidepressantsProviding solution for measuring long term childhood outcomes: time varying confounding factors e.g. breastfeeding
MSNovel statistics to handle rare diseases and small sample sizes.
MigraineDemonstrating solutions for studying intermittent medication exposures in diseases with episodic manifestations during pregnancy.
Pregnancy associated Breast CancerStudying drug exposure when disease is measured through accurate identification of an incident case.

WP2: Improving studies using primary data collection and spontaneous reports

In this work package, we contributed with expertise on neurodevelopmental outcomes.

The following consensus was published.
 Bromley RL, Bickle Graz M, Bluett-Duncan M, Chambers C, Damkier P, Dietrich K, Dolk H, Grant K, Mattson S, Meador KJ, Nordeng H, Oberlander TF, Ornoy A, Revet A, Richardson J, Rovet J, Schuler-Faccini L, Smearman E, Simms V, Vorhees C, Wide K, Wood A, Yates L, Ystrom E, Supraja TA, Adams J. Expert consensus on neurodevelopmental outcomes in pregnancy pharmacovigilance studies. Front Pharmacol. 2023 Jun 1;14:1094698. 

WP3 and WP4: Medications & Breastfeeding

UIO was responsible and completed one human lactation study. In total, 32 women from Norway contributed with milk samples. The results showed minimal breast milk transfer of cetirizine, with an estimated absolute infant daily dose of 2.5 μg/kg and a relative infant daily dose of less than 2% confirming that breastfeeding is compatible with use of (levo)cetirizine.

Cartoon in Norwegian: Panel 1: Woman with child blowing her nose on a bench in the park. Caption: "Allergisesongen er i gang". Panel 2: woman looking down at her breastfeeding child, thinking: "Lurer på hvor mye av medisinene som går over i morsmelken?" Caption: "Ammer du og bruker allergimedisinene Cetirizin, Zyrtec eller Xyzal?" Panel 3: woman giving vial to researcher in whote coat, saying: "Her er morsmelken min!" Caption: "Kan du tenke deg å donere morsmelkprøver til en studie ved Universitetet i Oslo?" Panel 4: the seal of the University of Oslo. Caption: "Ditt bidrag kan hjelpe oss fremskaffe ny kunnskap om allergi, amming og medisiner!

Website of the Levocetirizine study

WP5: Development of a knowledge bank and training program

Hedvig Nordeng has drafted the training module on Medications & Breastfeeding

WP7: Data analytical pipeline and ConcePTION Common Data Model

Work in this work package was instrumental in creating and testing out tools for analyzing heterogenous heath data across Europe using the ConcePTION Common Data Model. The ConcePTION Pregnancy algorithm identified pregnancies from birth registries and patient registries.

Read about the concept here:

Thurin NH, Pajouheshnia R, Roberto G, Dodd C, Hyeraci G, Bartolini C, Paoletti O, Nordeng H, Wallach-Kildemoes H, Ehrenstein V, Dudukina E, MacDonald T, De Paoli G, Loane M, Damase-Michel C, Beau AB, Droz-Perroteau C, Lassalle R, Bergman J, Swart K, Schink T, Cavero-Carbonell C, Barrachina-Bonet L, Gomez-Lumbreras A, Giner-Soriano M, Aragón M, Neville AJ, Puccini A, Pierini A, Ientile V, Trifirò G, Rissmann A, Leinonen MK, Martikainen V, Jordan S, Thayer D, Scanlon I, Georgiou ME, Cunnington M, Swertz M, Sturkenboom M, Gini R. From Inception to ConcePTION: Genesis of a Network to Support Better Monitoring and Communication of Medication Safety During Pregnancy and Breastfeeding. Clin Pharmacol Ther. 2022 Jan;111(1):321-331.

Publications

Work in WP3 and WP4 have resulted in several publications including:

  • Limoncella G, Girardi A, Bartolini C, Hyeraci G, Roberto G, Paoletti O, Messina D, Villalobos F, Bisacco CA, van den Berg J, Houben E, Santaca k, Ingrasciotta Y, Trifiro G, Pellegrini G, Ientile V, Hoxhaj V, Duran C, Riera-Arnau J, Garcia-Poza P, Martin-Perez M, Llorente-Garcia A, Cea-Soriano L, Huerta-Alvarez C, Sanchez-Saez F, Sanfelix-Gimeno G, Rodriguez-Bernal CL, Jove J, Bernard MA, Thurin NH, Jordan S, Thayer D, Evans HT, Coldea AI, Manfrini M, Van Gelder M, Tari M, Pajouheshnia R, Afonso Maciel AS, Le Noan-Laine M, Molgaard-Nielsen D, Cunnington M, Dodd C, Grilli L, Andaur Navarro CL, Sturkenboom M, Nordeng H, Gini R. Identifying pregnancies in population-based data sources: development and application of the concePTION pregnancy algorithm. Drug Saf. 2026 Aug;35(8):e70438. doi: 10.1002/pds.70438
  • Nordeng H, Wegler C, Lindqvist A, Melander E, Magnusson M, Gandia P, Panchaud A, Baranczewski P, Spigset O. Transfer of cetirizine/levocetirizine into human breast milk and estimation of drug exposure to infants through breastfeeding: A human lactation study from the ConcePTION project. Basic Clin Pharmacol Toxicol. 2024 Jan;134(1):153-164.
  • Cardoso E, Guidi M, Nauwelaerts N, Nordeng H, Teil M, Allegaert K, Smits A, Gandia P, Edginton A, Ito S, Annaert P, Panchaud A. Safety of medicines during breastfeeding - from case report to modeling: a contribution from the ConcePTION project. Expert Opin Drug Metab Toxicol. 2023 Jan-Jun;19(5):269-283.
  • Nauwelaerts N, Deferm N, Smits A, Bernardini C, Lammens B, Gandia P, Panchaud A, Nordeng H, Bacci ML, Forni M, Ventrella D, Van Calsteren K, DeLise A, Huys I, Bouisset-Leonard M, Allegaert K, Annaert P. A comprehensive review on non-clinical methods to study transfer of medication into breast milk – A contribution from the ConcePTION project. Biomed Pharmacother. 2021 Apr;136:111038. doi: 10.1016/j.biopha.2020.111038. Epub 2021 Jan 30. PMID:33526310.
  • Cardoso E, Monfort A, Ferreira E, Nordeng H, Winterfeld U, Allegaert K, Gandia P, Guidi M, Panchaud A. Maternal drugs and breastfeeding: Risk assessment from pharmacokinetics to safety evidence - A contribution from the ConcePTION project. Therapie. 2023 Mar-Apr;78(2):149-156. doi: 10.1016/j.therap.2023.01.008. Epub 2023 Jan 31. PMID: 36804048.
  • Monfort A, Cardoso E, Eap CB, Ansermot N, Crettol S, Fischer Fumeaux CJ, Graz MB, Harari MM, Weisskopf E, Gandia P, Allegaert K, Annaert P, Nordeng H, Hascoët JM, Claris O, Epiney M, Ferreira E, Leclair G, Csajka C, Panchaud A, Guidi M; Collaborators of the SSRI Breast Milk study. A population pharmacokinetic model for sertraline in women during the perinatal period-A contribution from the ConcePTION project. Br J Clin Pharmacol. 2024 Jul 19. doi: 10.1111/bcp.16177. Epub ahead of print. PMID: 39030897.
  • Monfort A, Cardoso E, Eap CB, Fischer Fumeaux CJ, Graz MB, Morisod Harari M, Weisskopf E, Gandia P, Allegaert K, Nordeng H, Hascoët JM, Claris O, Epiney M, Csajka C, Guidi M, Ferreira E, Panchaud A. Infant exposure to Fluvoxamine through placenta and human milk: a case series - A contribution from the ConcePTION project. Front Psychiatry. 2023 May 18;14:1167870. doi: 10.3389/fpsyt.2023.1167870. PMID: 37275991; PMCID: PMC10232980.

Collaborators

The ConcePTION project unites an 88 organizations from 22 countries, including the European Medicines Agency, drug manufacturers, academia, public health organizations, and teratology networks to innovate new solutions to a decades-long public health issue.

Participants

Published Oct. 8, 2024 12:04 PM - Last modified Sep. 9, 2026 2:50 PM