Use of prescription and non-prescription drugs in pregnancy

doi:10.1016/0895-4356(93)90132-K

Journal of Clinical Epidemiology

Volume 46, Issue 6, June 1993, Pages 581-589

https://doi.org/10.1016/0895-4356(93)90132-K Get rights and content

Abstract

We analyzed use of therapeutic drugs during pregnancy by 2752 mothers of infants without major congenital malformations. During pregnancy, 68% of the women used at least one prescription or non-prescription drug. Drug use in pregnancy was significantly more common for women who were white, older, married, better educated, of higher income and occupational status, receiving private prenatal care and not living in urban areas. Number of maternal illnesses, higher socioeconomic status, white race, multiparity and use of recreational drugs explained 26% of reported drug use. The mean number of drugs reported (1.2) underestimates total drug exposure due to exclusion of some drug categories including multivitamins and illicit drugs. Since the majority of women giving birth to normal infants report use of at least one pharmacologic agent during pregnancy, attribution of adverse outcome to drug use in an individual case is rarely justified.

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Cited by (87)

Case-control analysis of maternal prenatal analgesic use and cardiovascular malformations: Baltimore-Washington Infant Study
2014, American Journal of Obstetrics and Gynecology
Citation Excerpt :
However, >90% of the home interviews for both cases and controls were completed within 12 months of the infant's birth and the interview questions related drug use to specific medical indications.10,29 A low likelihood of recall bias is also suggested by a previous analysis of reported drug use within the BWIS data, which showed no significant differences between the number of drugs reported by the time elapsed between delivery and interview.13 As the time period of exposure spans up to 3 months before the last menstrual period, there may be a bias towards the null, as the half-life of most analgesics is <30 hours.30
We sought to assess maternal prenatal use of analgesics and risk of cardiovascular malformations (CVM) in the offspring.
Data from the Baltimore–Washington Infant Study, a population-based case-control investigation of CVM, were used to examine selected isolated CVM diagnoses and maternal analgesic use during the periconceptional period (3 months before and after conception). We compared case and control infants on frequency of maternal use of analgesics and estimated adjusted odds ratios (adjORs) and 95% confidence intervals (CI) with logistic regression models for specific CVM phenotypes.
Frequency of periconceptional use of any analgesic was 52% among control mothers and 53% among case mothers. Analyses by CVM diagnoses identified an association of tetralogy of Fallot with maternal acetaminophen use (adjOR, 1.6; 95% CI, 1.1–2.3) and dextrotransposition of the great arteries with intact ventricular septum with maternal nonsteroidal antiinflammatory drug use (adjOR, 3.2; 95% CI, 1.2–8.7).
Analgesic use during the periconceptional period was not associated with CVM in the aggregate or with most phenotypes of CVM examined. Associations with 2 phenotypes of CVM may have occurred by chance. These findings warrant corroboration and further study, including further evaluation of the observed associations, the dose of analgesic taken, more specific timing of analgesic use, and indications for use.
Effect of endogenous steroid hormones on 17-alpha-hydroxyprogesterone caproate metabolism
2013, American Journal of Obstetrics and Gynecology
Citation Excerpt :
In addition to the 17-OHPC/endogenous steroid interaction that was observed, both body mass index and race have been shown to impact the concentration of 17-OHPC in patients with a twin gestation who received a standard dose of the medication.2 Also, several commonly prescribed medications in pregnancy are also substrates, inhibitors, and/or inducers of CYP3A4.18-21 These factors may also contribute to the large interindividual variability that was observed in 17-OHPC plasma concentrations.
Plasma concentrations of 17-alpha-hydroxyprogesterone caproate (17-OHPC) vary substantially in pregnant patients who receive an identical dose. Endogenous steroid hormones may alter 17-OHPC metabolism, which contributes to this large variability.
Pooled human liver microsomes were incubated with 17-OHPC alone or in combination with progesterone, hydroxyprogesterone, estrone, estradiol, or estriol. High-performance liquid chromatography with ultraviolet detection was used to quantify 17-OHPC.
Under the conditions that were studied, 17-OHPC metabolism was inhibited by 37% by a combination of endogenous steroid hormones. Progesterone alone significantly inhibited 17-OHPC metabolism by 28% (P < .001).
17-OHPC metabolism is inhibited significantly by endogenous steroids and, in particular, progesterone. This effect may account for some of the large variation in plasma 17-OHPC concentrations that is seen in pregnant patients who receive a fixed dose of medication.
The effect of using the health smart card vs. CPOE reminder system on the prescribing practices of non-obstetric physicians during outpatient visits for pregnant women in Taiwan
2012, International Journal of Medical Informatics
Citation Excerpt :
Therefore, according to the result of this study, we estimate that there might be around 50,000 pregnant women every year receive medications that are harmful to the developing fetus, which is about 25% of all total pregnancies. Although this figure is still lower than for the US and France [8–16], important problems still remains. During the study, we found that an emergency setting had a significant effect.
There is an evidence that pregnant women have been prescribed a significant number of improper medications that could lead to potential damage for a developing fetus due to discontinuity of care. The safety of pregnant women raises public concern and there is a need to identify ways to prevent potential adverse events to the pregnant woman. This study used a health smart card with a clinical reminder system to keep continuous records of general outpatient visits of pregnant women to protect them from potential adverse events caused by improper prescription.
The health smart card, issued to all 23 million citizens in Taiwan, was used to work with a Computerized Physician Order Entry (CPOE) implemented at a 700-bed teaching medical center in Taipei to provide the outpatient information of pregnant women. FDA pregnancy risk classification was used to categorize the risk of pregnant women. The log file, combined with the physicians’ and patients’ profiles, were statistically examined using the Mantel–Haenszel technique to evaluate the impact of system in changing physician's prescription behavior.
A total of 441 patients ranged in age from 15 to 50 years with 1114 prescriptions involved in FDA pregnancy risk classification C, D, and X during the study period. 144 reminders (13.1%) were accepted by physicians for further assessment and 100 (69.4%) of them were modified. Non-obstetric physicians in non-emergency setting were more intended to accept reminders (27.8%, 4.9 folds than obstetricians). Reminders triggered on patients in second trimester (15.5%) were accepted by all physicians more than third trimester (OR 1.52, p < 0.05).
A health smart card armed with CPOE reminder system and well-defined criteria had the potential to decrease harmful medication prescribed to pregnant patients. The results show better conformance for non-obstetric physicians (26%) and when physicians accepted the alerts they are more likely to went back and review their orders (69%). In sum, reminder criteria of FDA pregnancy risk classification C for obstetricians and reminder based on different trimesters is suggested to be refined to improve system acceptability and to decrease improper prescription.
Prescription Drug Use in Pregnancy: A Retrospective, Population-Based Study in British Columbia, Canada (2001-2006)
2012, Clinical Therapeutics
Citation Excerpt :
Far fewer studies have examined antenatal prescription drug use in the North American context, and among those that have been published, estimates of use range widely: 27% to 64% of pregnant women using at least 1 medicine,7–11 and 4.0% to 6.5% using at least 1 medicine with the potential for fetal harm as defined by the US Food and Drug Administration (FDA) classification system or an expert panel.8,9,11,12 Studies in the United States and Canada have been limited to random or convenience samples of specific health centers9,10,13 or to populations of women covered by particular public or private insurance plans.8,11,14 Variation in the sampled populations and methodologies used to obtain these estimates raise questions about generalizability and make it difficult to confidently draw conclusions about the extent and patterns of antenatal drug use in North America.
Owing to the paucity of evidence available on the risks and benefits of drug use in pregnancy, the use of prescription medicines is a concern for both pregnant women and their health care providers.
The aim of this study was to measure the frequency, timing, and type of medicines used before, during, and after pregnancy in a Canadian population.
This retrospective cohort analysis used population-based health care data from all pregnancies ending in live births in hospitals in British Columbia from April 2001 to June 2006 (n = 163,082). Data from hospital records were linked to those in outpatient prescription-drug claims. Data from prescriptions filled from 6 months before pregnancy to 6 months postpartum were analyzed. Drugs were classified by therapeutic category and US Food and Drug Administration (FDA) pregnancy risk categories.
Prescriptions were filled in 63.5% of pregnancies. Evidence on safety is limited for many of the medicines most frequently filled in pregnancy, including codeine, salbutamol, and betamethasone. At least 1 prescription for a category D or X medicine was filled in 7.8% of pregnancies (5.5% category D; 2.5% category X). The most frequently filled prescriptions for category D drugs were benzodiazepines and antidepressants. The most frequently filled prescriptions for category X drugs were oral contraceptives and ovulation stimulants filled in the first trimester.
The majority of pregnant women in British Columbia filled at least 1 prescription, and ∼1 in 13 filled a prescription for a drug categorized as D or X by the FDA. The prevalence of maternal prescription drug use emphasizes the need for postmarketing evaluation of the risk–benefit profiles of pharmaceuticals in pregnancy. Future research on prenatal drug use based on administrative databases should examine maternal treatment adherence and the determinants of maternal drug use, considering maternal health status, sociodemographics, and the characteristics and providers of prenatal care.
The use, perceptions and knowledge of safety of over-the-counter medications during pregnancy in a Canadian population
2023, Women's Health
Association of postpartum medication practices with early breastfeeding cessation among mothers with chronic conditions: A prospective cohort study
2023, Acta Obstetricia et Gynecologica Scandinavica

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Pharmacoepidemiology reportUse of prescription and non-prescription drugs in pregnancy

Abstract

Clin Perinatol

Am J Obstet Gynecol

Am J Obstet Gynecol

Pediatr Clin North Am

Am J Obstet Gynecol

Catalog of Teratologic Agents

Chemically Induced Birth Defects

Changing trends in drug use during pregnancy

J Reprod Med

Drug ingestion during pregnancy: Infrequent exposure in a contemporary United States sample

Am J Perinatol

Pharmacoepidemiology report
Use of prescription and non-prescription drugs in pregnancy