Safety profile of medication used during pregnancy: results of a multinational European study

Assessment of self-medication practices and safety profile of medicines utilisation among pregnant women attending antenatal clinics in Freetown, Sierra Leone: a multicentre cross-sectional study

Background

Despite the potential foetal and maternal risks of self-medication, studies on self-medication practice and the safety profile of medicines used during pregnancy are scarce in our setting. This study determined the self-medication practice and safety profile of medicines used among pregnant women.

Methods

This cross-sectional study was conducted in face-to-face interviews among 345 pregnant women at three hospitals in Sierra Leone. Data were analysed using descriptive statistics and binary logistic regression to determine the prevalence and associated factors of self-medication.

Results

A total of 345 pregnant women participated in the study. The prevalence of self-medication prevalence among pregnant women with conventional and/or herbal medicine was 132 (38.3%). Also, 93 (75%) of the conventional medicines (CMs) were categorised as probably safe, of which paracetamol 36 (29.0%) was commonly used, followed by amoxicillin 23 (18.5%) and antimalarials 22 (17.7%) for common illnesses such as headache 30 (25.4%), urinary tract infection 23 (19.4%) and malaria 22 (18.6%). The most common reason for self-medication was previous experience with the disease 24 (27.3%). Luffa acutangula 19 (30.2%) was the most used herbal medicine (HM), and Oedema 30 (47.6%) was the most reported ailment. Among the HM users, 34 (54.0%) believe they are more effective than CMs. Secondary school education (AOR = 2.128, 95%CI = 1.191-3.804, p = 0.011), tertiary education (AOR = 2.915, 95%CI = 1.104-7.693, p = 0.031), monthly income of greater than NLe 1,000 (AOR = 4.084, 95% CI = 1.269-13.144, p = 0.018), and perceived maternal illness (AOR = 0.367, CI = 0.213-0.632, p = <0.001) were predictors of self-medication.

Conclusion

Self-medication practice was highly prevalent and was associated with educational status, monthly income, and perceived maternal illness during pregnancy. Therefore, intervention programmes should be designed and implemented to minimise the practice and risk associated with self-medication among pregnant women.

Racial Disparities in Medication Use During Pregnancy: Results from the NISAMI Cohort

Purpose

This study aimed to evaluate racial disparities in medication use and associated factors among pregnant women receiving prenatal care at Brazilian Unified Health System primary care health units in the northeast region.

Patients and Methods

A total of 1058 pregnant women in the NISAMI Cohort were interviewed between June 2012 and February 2014. Medicines used during pregnancy were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and ANVISA pregnancy risk categories. Prevalence ratios (crude and adjusted) and 95% confidence intervals (CIs) were estimated using Poisson regression with robust error variance. All analyses were stratified by race (Asian, black, brown/mixed, Brazilian indigenous, and white).

Results

Approximately 84% of the pregnant women used at least one medication, with a lower proportion among white women. The most reported medications were antianemic preparations (71.08%; 95% CI 68.27-73.72%), analgesics (21.74%; 95% CI 19.36-24.32%), and drugs for functional gastrointestinal disorders (18.81%; 95% CI 16.57-21.28%). Approximately 29% of women took potentially risky medications during pregnancy, with a higher prevalence among Asian and white women. Factors associated with medication use during pregnancy include a greater number of prenatal consultations, higher education levels, health problems, and smoking. In addition, maternal age above 25 years, smoking status, and two or more previous pregnancies were associated with potentially risky medication use during pregnancy.

Conclusion

A high prevalence of medication use during pregnancy was found; however, this prevalence was lower among white women. Nonetheless, black and brown women used antianemic preparations less frequently. This finding suggests that race is a factor of inequity in prenatal care, demanding public policies to mitigate it.

Use of privacy-preserving record linkage to examine the dispensing of pharmaceutical benefits scheme medicines to pregnant women in Western Australia

PURPOSE

Medications are commonly used during pregnancy to manage pre-existing conditions and conditions that arise during pregnancy. However, not all medications are safe to use in pregnancy. This study utilized privacy-preserving record linkage (PPRL) to examine medications dispensed under the national Pharmaceutical Benefits Scheme (PBS) to pregnant women in Western Australia (WA) overall and by medication safety category.

METHODS

In this retrospective, cross-sectional, population-based study, state perinatal records (Midwives Notification Scheme) were linked with national PBS dispensing data using PPRL. Live and stillborn neonates born between 2012 and 2019 in WA were included. The proportion of pregnancies during which the mother was dispensed a PBS medication was calculated, overall and by medication safety category. Factors associated with PBS medication dispensing were examined using logistic regression.

RESULTS

PPRL linkage identified matching records for 97.4% of women with perinatal records. A total of 271 739 pregnancies were identified, with 158 585 (58.4%) pregnancies involving the dispensing of at least one PBS medication. Category A medications (those considered safe in pregnancy) were the most commonly dispensed (n = 119 126, 43.8%) followed by B3 (n = 51 135, 18.8%) and B1 (n = 42 388, 15.6%) medication (those with unknown safety). Over the study period, the dispensing of PBS medications in pregnancy increased (OR: 1.06, 95%CI: 1.06, 1.07). The strongest predictor of medication dispensing in pregnancy was pre-pregnancy dispensing (OR: 3.61, 95%CI: 3.54, 3.68). Other factors associated with medication use in pregnancy were smoking, older maternal age, obesity, and prior pregnancies.

CONCLUSION

Privacy preserving record linkage provides a way to link cross-jurisdictional data while preserving patient confidentiality and data security. The dispensing of PBS medication in pregnancy was common and increased over time, with approximately 60% of women dispensed at least one medication during pregnancy.

Assessment of the scope, completeness, and consistency of various drug information resources related to COVID-19 medications in pregnancy and lactation

BACKGROUND

Drug use in pregnancy and lactation is challenging. It becomes more challenging in pregnant and lactating women with certain critical clinical conditions such as COVID-19, because of inconsistent drug safety data. Therefore, we aimed to evaluate the various drug information resources for the scope, completeness, and consistency of the information related to COVID-19 medications in pregnancy and lactation.

METHODS

Data related to COVID-19 medications from various drug information resources such as text references, subscription databases, and free online tools were used for the comparison. The congregated data were analyzed for scope, completeness, and consistency.

RESULTS

Scope scores were highest for Portable Electronic Physician Information Database (PEPID), Up-to-date, and drugs.com compared to other resources. The overall completeness scores were higher for Micromedex and drugs.com (p < 0.05 compared to all other resources). The inter-reliability analysis for overall components by Fleiss kappa among all the resources was found to be 'slight' (k < 0.20, p < 0.0001). The information related to the older drugs in most of the resources, provides in-depth details on various components such as pregnancy safety, clinical data related to lactation, the effect of the drug distribution into breast milk, reproductive potential/infertility risk and the pregnancy category/recommendations. However, the information related to these components for newer drugs was superficial and incomplete, with insufficient data and inconclusive evidence, which is a statistically significant observation. The strength of observer agreement for the various COVID-19 medications ranged from poor to fair and moderate for the various recommendation categories studied.

CONCLUSION

This study reports discrepancies in the information related to pregnancy, lactation, drug level, reproductive risk, and pregnancy recommendations among the resources directing to refer to more than one resource for information about the safe and quality use of medications in this special population.The present study also emphasizes the need for development of comprehensive, evidence-based, and precise information guide that can promote safe and effective drug use in this special population.

embryoTox: Using Graph-Based Signatures to Predict the Teratogenicity of Small Molecules

Teratogenic drugs can lead to extreme fetal malformation and consequently critically influence the fetus's health, yet the teratogenic risks associated with most approved drugs are unknown. Here, we propose a novel predictive tool, embryoTox, which utilizes a graph-based signature representation of the chemical structure of a small molecule to predict and classify molecules likely to be safe during pregnancy. embryoTox was trained and validated using in vitro bioactivity data of over 700 small molecules with characterized teratogenicity effects. Our final model achieved an area under the receiver operating characteristic curve (AUC) of up to 0.96 on 10-fold cross-validation and 0.82 on nonredundant blind tests, outperforming alternative approaches. We believe that our predictive tool will provide a practical resource for optimizing screening libraries to determine effective and safe molecules to use during pregnancy. To provide a simple and integrated platform to rapidly screen for potential safe molecules and their risk factors, we made embryoTox freely available online at https://biosig.lab.uq.edu.au/embryotox/.

Potentially harmful medication use and the associated factors among pregnant women visiting antenatal care clinics in Mbarara Regional Referral Hospital, Southwestern Uganda

Background

Pregnancy management using medications has been challenging for both healthcare providers and pregnant women, given the fear of teratogenicity effects and the potential for fetal harm. In the developing world, poor health-seeking behavior of patients, delayed initiation of antenatal care (ANC), and low level of educational status of mothers could contribute to the issue of drug safety in pregnancy.

Aim

The aim of the study was to determine the prevalence and factors associated with potentially harmful medication use in pregnancy.

Methods

A cross-sectional study was conducted from April 1 to June 6, 2021, including 209 pregnant women on ANC follow-up at a referral hospital in Southwestern Uganda. The simple random sampling technique was employed to select study participants. Interviewer-administered questionnaires were used to collect the history of medication use since conception and then the participant's ANC card was reviewed to determine prescribed drug regimens and their indications. Statistical Package for the Social Sciences version 23.0 was used for analysis.

Results

Out of the 1,422 medications used by 209 women, 665 (42.2%) were category C, and 182 (11.5%) were category A. A total of 92 (44.0%) pregnant women used at least one potentially harmful medication during the current pregnancy. Having more than average monthly income (adjusted odds ratio [aOR] = 2.32 [1.04, 5.14 at 95% confidence interval (CI)]), having a chronic disease (aOR = 3.24 [1.17, 8.97 at 95% C.I]), using 7 and more medications (aOR = 9.12 [4.11, 20.24 at 95% CI]), and use of herbal medicines (aOR = 4.50 [2.10, 9.87 at 95% CI]) were shown to be risk factors.

Conclusion

The proportion of pregnant women that used at least one potentially harmful medication is higher than in previous studies. Having comorbidities and taking more medications increase the risk of receiving a potentially harmful medication during pregnancy.

Relevance to Patients

This study identified the gaps in the use of medicines during pregnancy which will enable the development and implementation of protocols for optimizing prescribing practices in pregnant women by focusing on the safety of the fetus.

Prescription pattern and associated factors among pregnant women attending antenatal clinics in University of Gondar, North West Ethiopia

Background

An inappropriate use of drug during pregnancy may harm the fetus. There is no enough study on drug use among pregnant women at the University of Gondar referral hospital. Most studies are carried out in developed countries but not in developing countries. Thus, the aim of this study was to evaluate prescription of drug and associated factors among pregnant women attending antenatal care service in University of Gondar referral hospital.

Methods

Institution based cross sectional study was used among 334 pregnant women who attended antenatal care units of the University of Gondar referral hospital. Data were collected from the pregnant women medical records and registration logbook and analyzed using SPSS version 23. Multivariate logistic regression used to analyze the association of the independent variables with drug use. P-values <0.05 were considered significant.

Result

A total of 334 pregnant women's medical records showed a total of 631 drugs prescribed. The average numbers of drugs per pregnant women was 1.88. All pregnant women (100%) were prescribed with iron folat. Most pregnant women 185 (55.2%) were in the third trimester followed by third trimester 91 (27.25%). Moreover, 23.77%, 42.95%, 33%, and 7% pregnant women encountered with drugs from category A, B, C and D respectively. From the bivariate regression analysis, Age of women, maternal illness, trimester at the first visit, and gravidity were significantly associated with exposure to prescribed drug use during pregnancy.

Conclusion

The present study showed the deviation of drug use pattern from the WHO optimal levels proposing the hospitals had inappropriate use of drug. Implementing corrective measures are required to achieve the recommended standards of appropriate drug use.

Engineered models for placental toxicology: Emerging approaches based on tissue decellularization

Recent increases in prescriptions and illegal drug use as well as exposure to environmental contaminants during pregnancy have highlighted the critical importance of placental toxicology in understanding and identifying risks to both mother and fetus. Although advantageous for basic science, current in vitro models often fail to capture the complexity of placental response, likely due to their inability to recreate and monitor aspects of the microenvironment including physical properties, mechanical forces and stiffness, protein composition, cell-cell interactions, soluble and physicochemical factors, and other exogenous cues. Tissue engineering holds great promise in addressing these challenges and provides an avenue to better understand basic biology, effects of toxic compounds and potential therapeutics. The key to success lies in effectively recreating the microenvironment. One strategy to do this would be to recreate individual components and then combine them. However, this becomes challenging due to variables present according to conditions such as tissue location, age, health status and lifestyle. The extracellular matrix (ECM) is known to influence cellular fate by working as a storage of factors. Decellularized ECM (dECM) is a recent tool that allows usage of the original ECM in a refurbished form, providing a relatively reliable representation of the microenvironment. This review focuses on using dECM in modified forms such as whole organs, scaffold sheets, electrospun nanofibers, hydrogels, 3D printing, and combinations as building blocks to recreate aspects of the microenvironment to address general tissue engineering and toxicology challenges, thus illustrating their potential as tools for future placental toxicology studies.

Explainable multimodal machine learning model for classifying pregnancy drug safety

MOTIVATION

Teratogenic drugs can cause severe fetal malformation and therefore have critical impact on the health of the fetus, yet the teratogenic risks are unknown for most approved drugs. This article proposes an explainable machine learning model for classifying pregnancy drug safety based on multimodal data and suggests an orthogonal ensemble for modeling multimodal data. To train the proposed model, we created a set of labeled drugs by processing over 100 000 textual responses collected by a large teratology information service. Structured textual information is incorporated into the model by applying clustering analysis to textual features.

RESULTS

We report an area under the receiver operating characteristic curve (AUC) of 0.891 using cross-validation and an AUC of 0.904 for cross-expert validation. Our findings suggest the safety of two drugs during pregnancy, Varenicline and Mebeverine, and suggest that Meloxicam, an NSAID, is of higher risk; according to existing data, the safety of these three drugs during pregnancy is unknown. We also present a web-based application that enables physicians to examine a specific drug and its risk factors.

AVAILABILITY AND IMPLEMENTATION

The code and data is available from https://github.com/goolig/drug_safety_pregnancy_prediction.git.

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

Dispensing of Potentially Harmful Prescription Drugs in 1.8 Million Pregnant Women in France: A Nationwide Study Based on Two Risk Classification Systems

Introduction

Nationwide prevalence of potentially harmful drug prescribing during pregnancy is unknown in France, and several risk classification systems (RCS) exist to guide prescribers.

Objective

The aim of this study was to estimate the nationwide prevalence of potentially harmful drug prescribing during pregnancy in France and to describe maternal characteristics associated with this prescription.

Methods

This drug utilisation study, conducted on the French health databases (67 million beneficiaries), included all pregnancies beginning in 2016–2017, regardless of pregnancy outcome. Potentially harmful drug prescribing was defined as at least one reimbursement during pregnancy of Swedish RCS category D drugs, Australian RCS category D/X drugs, or contraindicated drugs in France for drugs not listed in these two RCSs. Maternal characteristics associated with potentially harmful drug prescribing were described using a univariate logistic regression analysis.

Results

Among the 1,844,447 pregnant women identified, the prevalence of potentially harmful drug prescribing was higher according to the Australian RCS (3.9%) than according to the Swedish RCS (2.2%), with good agreement between the two RCSs (Kappa = 0.81 [0.74–0.87]). This prevalence increased to 9.2% and 6.9%, respectively, when considering contraindications in France. Prescribing of teratogenic drugs, including retinoids and valproate, was highest during the first trimester, whereas prescribing of foetotoxic drugs decreased after the first trimester but remained high for nonsteroidal anti-inflammatory drugs (N = 10,021). In women with no chronic diseases, polymedication (five or more drugs) was the strongest maternal characteristic associated with potentially harmful drug prescribing in both RCSs.

Conclusions

Potentially harmful drug prescribing during pregnancy is not uncommon in France. This study supports the comparative analysis of RCS to assess potentially harmful drug prescribing in claims databases.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40264-021-01117-4.

Prevalence and safety of prescription medicine use during pregnancy in the Republic of Suriname in the year 2017: a pharmacoepidemiological analysis

BACKGROUND

Using the claims database of the State Health Foundation from 2017, the prevalence and safety of prescription medicines given to pregnant women in Suriname (South America) have been determined.

METHODS

Prescription rates and proportions of the total number of prescriptions were calculated, overall and stratified for subgroups of age, region of residence, major Anatomical Therapeutic Chemical - and safety classification (Australian categorization system). Data were compared with the Σ²-test and the two samples test of proportions using normal theory method; p-values <0.01 were considered statistically significant differences.

RESULTS

Average prescription rates (number of prescriptions by number of patients) were 24.0, 29.7, and 32.5 in age groups 15-29, 30-44, and 45+ years, respectively (p<0.001), and 26.4, 23.0, and 14.0 in the urban-coastal, rural-coastal, and rural-interior region, respectively (p<0.001).

CONCLUSIONS

The use of prescription medicines was common (rates up to 40.4), ranged from antibiotics to vitamins, and most were safe. However, 3.2% (some antibiotics and antiepileptics) belonged to safety category D, carrying a definite human fetal risk. However, the potential benefits of these drugs warranted their use in pregnant women. These findings are largely in line with literature data, although future studies must verify their generalizability to the total Surinamese population.

Evaluation of the use and attitudes of pregnant and postpartum women towards medicine utilisation during pregnancy in the United Arab Emirates: A national cross-sectional study

INTRODUCTION

Pregnancy period is of high concern to every woman. Knowledge about medication use needs to be highlighted at such a critical stage.

OBJECTIVE

This study aimed to assess pregnant and postpartum women's use and attitude regarding the utilisation of medications during pregnancy in the United Arab Emirates (UAE).

METHODS

A self-administrated survey was distributed among 500 pregnant and postpartum women randomly selected from the general population of five different cities within the UAE: Abu Dhabi, Dubai, Sharjah, AL Fujairah and Ajman over a period of 3 months. All analyses were two-sided, and a P-value of ≤.05 was taken as the cut-off for statistical significance.

RESULTS

Overall, 434 participants took part in the survey. Forty-one percent of respondents reported that they use drugs during pregnancy, and the most frequently used medications during pregnancy were multivitamins, analgesics and folic acid. Moreover, 77.9% of female participants acquired their knowledge from their gynaecologists. Only 21.7% of respondents reported that the pharmacist provided enough information during dispensing. Most ladies had an uplifting mentality towards medicines, but they believed pregnant ladies should be more wary with respect to medication use during pregnancy. A significant association was found between participants' nationality and occupation, and attitudes about medications (P < .001), where women with Arab nationality and those with health-related careers agreed that they have a higher threshold for using medicines during pregnancy.

CONCLUSION

During pregnancy, ladies were more moderate and doubter towards the drug, healthcare providers should know about such mentalities while encouraging pregnant ladies to take prescription.

Patterns and determinants of prescribed drug use among pregnant women in Adigrat general hospital, northern Ethiopia: a cross-sectional study

Background

A vigilant prescription of drugs during pregnancy can potentially safeguard the growing fetus from the deleterious effect of the drug while attempting to manage the mother’s health problems. There is a paucity of information about the drug utilization pattern in the area of investigation. Hence, this study was implemented to investigate the pattern of drug utilization and its associated factors among pregnant women in Adigrat general hospital, Northern Ethiopia.

Methods

An institution-based cross-sectional study was conducted among randomly selected 314 pregnant women who attended obstetrics-gynecology and antenatal care units of the hospital. Relevant data were retrieved from the pregnant women’s medical records and registration logbook. The drugs prescribed were categorized based on the United States Food and Drug Administration (US-FDA) fetal harm classification system. Data analysis was done using SPSS version 20 statistical software. Multivariate logistic regression was employed to analyze the association of the explanatory variables with the medication use, and p < 0.05 was declared statistically significant.

Results

The overall prescribed drug use in this study was found to be 87.7%. A considerable percentage of the study participants (41.4%) were prescribed with supplemental drugs (iron folate being the most prescribed drug) followed by antibiotics (23.4%) and analgesics (9.2%). According to the US-FDA drug’s risk classification, 42.5, 37, 13, and 7% of the drugs prescribed were from categories A, B, C, and D or X respectively. Prescribed drug use was more likely among pregnant women who completed primary [AOR = 5.34, 95% CI (1.53–18.6)] and secondary education [AOR = 4.1, 95% CI (1.16–14)], who had a history of chronic illness [AOR = 7.9, 95% CI (3.14–19.94)] and among multigravida women [AOR = 2.9, 95% CI (1.57 5.45)].

Conclusions

The finding of this study revealed that a substantial proportion of pregnant women received drugs with potential harm to the mother and fetus. Reasonably, notifying health practitioners to rely on up-to-date treatment guidelines strictly is highly demanded. Moreover, counseling and educating pregnant women on the safe and appropriate use of medications during pregnancy are crucial to mitigate the burden that the mother and the growing fetus could face.

Prevalence and Associated Factors of Self-Medication among Pregnant Women on Antenatal Care Follow-Up at University of Gondar Comprehensive Specialized Hospital in Gondar, Northwest Ethiopia: A Cross-Sectional Study

Background

Self-medication is being prevalent throughout the globe. Although pregnant women are among the most vulnerable group of the population for drug-induced adverse effects on their fetus and themselves, many pregnant women use self-medication without adequate safety precautions.

Objective

This study was aimed at assessing the prevalence and associated factors of self-medication among pregnant women on antenatal care follow-up at University of Gondar Comprehensive Specialized Hospital.

Methods

A cross-sectional study was employed among 400 pregnant women attending antenatal care clinic at the University of Gondar Comprehensive Specialized Hospital between February 01 and May 30, 2019. A structured interviewer-administered questionnaire was used for data collection. Data were analyzed using SPSS® (IBM Corporation) version 22. Descriptive statistics were presented using frequency and proportion. Binary logistic regression was used to identify factors associated with self-medication with a 95% confidence level and p value of 0.05.

Results

Among 400 respondents, the prevalence of self-medication during the current pregnancy was 44.8% (95% CI = 40.5-50). Among all respondents (400), 38.0% (95% CI = 33.3-42.8) and 12.5% (95% CI = 9.5-15) used herbal and conventional medicine, respectively. Self-medication showed a significant association with a previous history of self-medication and monthly income.

Conclusions

The prevalence of self-medication among pregnant women is considerably high. The previous history of self-medication and monthly income showed a significant association with self-medication. Awareness creation should be done for reproductive-age women on the potential risks of self-medication.

Mechanisms of Key Innate Immune Cells in Early- and Late-Onset Preeclampsia

Preeclampsia is a complex cardiovascular disorder of pregnancy with underlying multifactorial pathogeneses; however, its etiology is not fully understood. It is characterized by the new onset of maternal hypertension after 20 weeks of gestation, accompanied by proteinuria, maternal organ damage, and/or uteroplacental dysfunction. Preeclampsia can be subdivided into early- and late-onset phenotypes (EOPE and LOPE), diagnosed before 34 weeks or from 34 weeks of gestation, respectively. Impaired placental development in early pregnancy and subsequent growth restriction is often associated with EOPE, while LOPE is associated with maternal endothelial dysfunction. The innate immune system plays an essential role in normal progression of physiological pregnancy and fetal development. However, inappropriate or excessive activation of this system can lead to placental dysfunction or poor maternal vascular adaptation and contribute to the development of preeclampsia. This review aims to comprehensively outline the mechanisms of key innate immune cells including macrophages, neutrophils, natural killer (NK) cells, and innate B1 cells, in normal physiological pregnancy, EOPE and LOPE. The roles of the complement system, syncytiotrophoblast extracellular vesicles and mesenchymal stem cells (MSCs) are also discussed in the context of innate immune system regulation and preeclampsia. The outlined molecular mechanisms, which represent potential therapeutic targets, and associated emerging treatments, are evaluated as treatments for preeclampsia. Therefore, by addressing the current understanding of innate immunity in the pathogenesis of EOPE and LOPE, this review will contribute to the body of research that could lead to the development of better diagnosis, prevention, and treatment strategies. Importantly, it will delineate the differences in the mechanisms of the innate immune system in two different types of preeclampsia, which is necessary for a more personalized approach to the monitoring and treatment of affected women.

Prescription drugs use during pregnancy in Ethiopia: A systematic review and meta-analysis

Background

The selection of safe drugs for pregnant women in developing countries, such as Ethiopia, where there are limited options of drugs would be challenging. Hence, the aim of this review was to determine the extent of prescribed drugs use and their potential to cause fetal harm among pregnant women in Ethiopia based on the United States Food and Drug Administration risk category.

Methods

Relevant studies were identified through systematic searches conducted in PubMed, HINARI, Google Scholar and Researchgate. Data on study characteristics and outcomes were extracted using the format developed in Microsoft Excel. The primary measure was pooled prevalence of prescription drugs use during pregnancy. The I² index was used to assess heterogeneity among studies. The presence of publication bias across studies was evaluated using funnel plot. A random effects model was used to estimate the pooled prevalence.

Results

A total of nine studies published between 2013 and 2019 were included. The pooled prevalence of prescription drugs during pregnancy, excluding minerals and vitamins, was 45.9 (95%CI: 29.3, 62.5)%. The pooled prevalence of prescription drug use, including minerals and vitamins, was 86.9 (95%CI: 81.2, 92.6)%. The pooled proportion of medications used based on the United States Food and Drug Administration risk category was 56.1 (95%CI: 43.0, 68.4)%, 29.0 (95%CI: 27.9, 30.1)%, 12.1 (95%CI: 7.9, 18.1)%, 4.1 (95%CI: 3.6, 4.6)%, and 2.5 (95%CI: 1.8, 3.6)% for the United States Food and Drug Administration fetal risk category "A," "B," "C," "D," and "X," respectively.

Conclusion

The use of prescription drugs during pregnancy, excluding supplements, in Ethiopia was high. Drugs with evidence of fetal harm were widely used. Hence, health care providers should select relatively safe drugs. Stakeholders should ensure safe prescribing practice for pregnant women through developing guidelines and updating professionals on the fetal risk status of commonly prescribed drugs.

Self-Medication and Safety Profile of Medicines Used among Pregnant Women in a Tertiary Teaching Hospital in Jimma, Ethiopia: A Cross-Sectional Study

Background: Despite the potential foetal and maternal risks of self-medication, studies on self-medication and safety profile of medicines used during pregnancy are scarce. This study determined the prevalence, predictors and safety profile of medicines used for self-medication during pregnancy at Jimma University Medical Centre (JUMC) in Ethiopia. Methods: A hospital-based cross sectional study was conducted on 1117 hospitalized pregnant women or postpartum women in the maternity and gynaecology wards at JUMC between February and June 2017. Data were collected using an interviewer-administered structured questionnaire and by reviewing patient medical records. Data were analysed using descriptive statistics and logistic regression. Result: Nearly 3 out of 10 women reported taking at least one type of conventional medicine for self-medication, mainly analgesics 92.3%. Almost 75.0% of the self-medicated women used medicines classified as probably safe and 13.6% as potentially risky to use during pregnancy. Medicinal plant use, religion and access to a health facility near their residency were significantly associated with self-medication during pregnancy. Conclusions: Self-medication is common among pregnant women at JUMC. Most women used medicines classified as safe to use during pregnancy. There is need for enlightenment of pregnant women on the potential dangers of self-medication during pregnancy to prevent foetal and maternal risks.

Pharmacoepidemiologic Evaluation of Birth Defects from Health-Related Postings in Social Media During Pregnancy

Introduction

Adverse effects of medications taken during pregnancy are traditionally studied through post-marketing pregnancy registries, which have limitations. Social media data may be an alternative data source for pregnancy surveillance studies.

Objective

The objective of this study was to assess the feasibility of using social media data as an alternative source for pregnancy surveillance for regulatory decision making.

Methods

We created an automated method to identify Twitter accounts of pregnant women. We identified 196 pregnant women with a mention of a birth defect in relation to their baby and 196 without a mention of a birth defect in relation to their baby. We extracted information on pregnancy and maternal demographics, medication intake and timing, and birth defects.

Results

Although often incomplete, we extracted data for the majority of the pregnancies. Among women that reported birth defects, 35% reported taking one or more medications during pregnancy compared with 17% of controls. After accounting for age, race, and place of residence, a higher medication intake was observed in women who reported birth defects. The rate of birth defects in the pregnancy cohort was lower (0.44%) compared with the rate in the general population (3%).

Conclusions

Twitter data capture information on medication intake and birth defects; however, the information obtained cannot replace pregnancy registries at this time. Development of improved methods to automatically extract and annotate social media data may increase their value to support regulatory decision making regarding pregnancy outcomes in women using medications during their pregnancies.

Placental transporter-mediated drug interactions and offspring congenital anomalies

Aims

P‐glycoprotein (P‐gp) and breast cancer resistance protein (BCRP) are efflux transporters expressed in the placenta, limiting their substrates from reaching the foetus. Our aim was to investigate if concomitant prenatal exposure to several substrates or inhibitors of these transporters increases the risk of congenital anomalies.

Methods

The national Drugs and Pregnancy database, years 1996–2014, was utilized in this population‐based birth cohort study. In the database, the Medical Birth Register, the Register on Induced Abortions, the Malformation register and the Register on Reimbursed Drug Purchases have been linked. The University of Washington Metabolism and Transport Drug Interaction Database was used to identify substrates and inhibitors of P‐gp and BCRP. We included singleton pregnancies ending in birth or elective termination of pregnancy due to foetal anomaly. Known teratogens were excluded. We identified women exposed 1 month before pregnancy or during the first trimester to P‐gp/BCRP polytherapy (n = 21 186); P‐gp/breast cancer resistance protein monotherapy (n = 97 906); non‐P‐gp/BCRP polytherapy (n = 78 636); and unexposed (n = 728 870). We investigated the association between the exposure groups and major congenital anomalies using logistic regression adjusting for several confounders.

Results

The prevalence of congenital anomalies was higher in the P‐gp/BCRP polytherapy group (5.5%) compared to the P‐gp/BCRP monotherapy (4.7%, OR 1.13; 95% CI 1.05–1.21), the non‐P‐gp/BCRP polytherapy (4.9%, OR 1.14; 95% CI 1.06–1.22), and to the unexposed groups (4.2%, OR 1.23; 95% CI 1.15–1.31).

Conclusion

The results suggest a role of placental transporter‐mediated drug interactions in teratogenesis.

Bayesian hierarchical methods in the detection of potentially teratogenic first-trimester medications

PURPOSE

Bayesian hierarchical models (BHMs) have been used to identify adverse drug reactions, allowing information sharing amongst adverse reactions and drugs expected to have similar properties. This study evaluated the use of BHMs in the routine signal detection analyses of potential first-trimester teratogens, where these models have not previously been applied.

METHODS

Data on 15 058 malformed foetuses exposed to first trimester medications (1995-2011) from 13 European congenital anomaly (CA) registries were analysed. The proportion of each CA in women taking a specific medication was compared with the proportion of that CA in all other women in the dataset (55 CAs × 523 medications). BHMs were grouped by either medications or CAs or by both simultaneously, and the results compared with analysing each medication-CA combination separately and adjusting for multiplicity using a double false discovery rate (FDR) procedure. The proportions of "high-risk" medications (medications which have been shown to carry a moderate to high risk of foetal malformations) identified as potential signals were compared, as well as the total number of potential signals requiring follow up (the effective workload).

RESULTS

BHMs identified more high-risk medications than the double FDR method, but the effective workload was larger. A BHM grouping both medications and CAs, for example, identified 23% of high-risk medications compared with 14% by the double FDR; however, there was an increase from 16 to 71 potential signals requiring follow up.

CONCLUSION

For comparable effective workloads, BHMs did not outperform the double FDR, which is comparatively straightforward to implement and is therefore recommended for continued use in teratogenic signal detection analyses.

A rapid desensitization protocol in a case of drotaverine-induced serum sickness-like reaction in a pregnant woman: A case report

Drotaverine is an antispasmodic drug used to treat gastrointestinal and genitourinary smooth muscle spasms. There are very few hypersensitivity reactions reported. Serum sickness-like disease is an immune-complex-mediated hypersensitivity reaction that presents with some typical features that include rash, fever and articular impairment sometimes associated with liver and renal dysfunctions, beginning 1-2 weeks after exposure to a culprit drug. Diagnosis is a clinical one, made usually on the basis of knowledge obtained by medical history and physical examination. Desensitization usually is recommended for type I reaction, but may be a solution for this type of immunological reaction when other therapeutic alternatives are ineffective or do not exist. We report the case of a 29-year-old pregnant female who developed serum sickness-like reaction after 5 days of daily drotaverine oral administration. The patient required antispasmodic treatment, with this drug, having a pregnancy with an imminent risk of abortion and the other therapeutic alternatives being ineffective. She underwent a rapid 7-step oral drotaverine desensitization protocol without recurrence of serum sickness-like reaction. To our knowledge, this is the first case report of desensitization to drotaverine, previously involved in a serum sickness-like reaction.

Safety of medication use during pregnancy in mainland China: based on a national health insurance database in 2015

Background

Medication safety during pregnancy has drawn global attention, little of which has been reported about the Chinese population. This study aims to describe patterns and risks of medication use among pregnant women in mainland China with reference to the U.S. Food and Drug Administration (FDA) pregnancy risk category.

Methods

Hospital diagnostic and drug dispensing information of a national representative sample of basic medical insurance (BMI) beneficiaries was obtained from the China Health Insurance Association (CHIRA) database in 2015. Prevalence of use and number of medicines involved in each risk category were calculated. Most commonly used medicines from each risk category were illustrated. Factors associated with the use of category D/X medicines were evaluated through multiple logistic regression.

Results

Out of 11,373 women who had singleton deliveries in 2015, there were 2896 women with records covering their entire pregnancies, 5377, and 7946 women with records through the 2nd, and the 3rd trimester, respectively. It was found that 11.1% pregnant women used at least one medication and a total of 321 medications had been used during pregnancy. Most pregnant women used medicines which were classified FDA category C (66.2%), followed by category B (57.8%), category A (16.8%), category X (7.5%) and category D (5.0%). The most commonly used medicines from category D and X were anxiolytics and hormonal preparations respectively. Women who were from mid-western area (p = 0.045) or used four or more medications (p < 0.001) were more likely to use category D/X medicines.

Conclusions

This study revealed that about one in ten pregnant women used at least one medication during pregnancy in China and a significant number of them used FDA Category D or X medicines. The usage patterns identified in the present study indicate that sub-optimal medicine use might exist warranting further evaluation and intervention in future studies. More efforts are needed to uncover the safety concerns about medication use during pregnancy and improve current information system for clinical practice.

Identifying signals of potentially harmful medications in pregnancy: use of the double false discovery rate method to adjust for multiple testing

AIMS

Surveillance of medication use in pregnancy is essential to identify associations between first trimester medications and congenital anomalies (CAs). Medications in the same Anatomical Therapeutic Chemical classes may have similar effects. We aimed to use this information to improve the detection of potential teratogens in CA surveillance data.

METHODS

Data on 15 058 malformed fetuses with first trimester medication exposures from 1995-2011 were available from EUROmediCAT, a network of European CA registries. For each medication-CA combination, the proportion of the CA in fetuses with the medication was compared to the proportion of the CA in all other fetuses in the dataset. The Australian classification system was used to identify high-risk medications in order to compare two methods of controlling the false discovery rate (FDR): a single FDR applied across all combinations, and a double FDR incorporating groupings of medications.

RESULTS

There were 28 765 potential combinations (523 medications × 55 CAs) for analysis. An FDR cut-off of 50% resulted in a reasonable effective workload, for which single FDR gave rise to eight medication signals (three high-risk medications) and double FDR 50% identified 16 signals (six high-risk). Over a range of FDR cut-offs, double FDR identified more high-risk medications as signals, for comparable effective workloads.

CONCLUSIONS

The double FDR method appears to improve the detection of potential teratogens in comparison to the single FDR, while maintaining a low risk of false positives. Use of double FDR is recommended in routine signal detection analyses of CA data.

Safety Profile of Drug Use During Pregnancy at Peripheral Health Centres in Burkina Faso: A Prospective Observational Cohort Study

PURPOSE

Safety data of many drugs used during pregnancy remain scarce. This is especially true in developing countries characterised by the absence of a robust pharmacovigilance system, high prevalence of different tropical diseases affecting patients and potential for drug-drug interactions. This study aimed to assess the safety profile of drugs used in women at high risk of malaria during pregnancy and delivery in Burkina Faso's health facilities. It also aimed to assess factors associated with the use of potentially risky drugs over the entire course of pregnancy.

METHODS

We enrolled pregnant women from their first antenatal care visit and followed them up until delivery, and collected data on drug use. Based on United States Food and Drug Administration (FDA) or Australian Therapeutic Goods Administration (TGA) drug risk classification, drugs were classified into three groups: 'probably safe', 'potentially risky' or 'unclassified'. A modified classification was built to take into account national malaria policy treatment guidelines and World Health Organization Malaria Treatment Guidelines recommending malaria chemoprophylaxis during pregnancy.

RESULTS

Out of 2371 pregnant women enrolled, 56.7% used at least one medication during the entire course of the pregnancy (excluding sulphadoxine-pyrimethamine and iron-folic acid). A total of 101 different types of medications were used by study participants and 36.6, 49.5 and 13.9% were, respectively, classified as 'probably safe', 'potentially risky' and 'unclassified'. Antimalarials and antibiotics were the most frequently used drugs. Around 39% of women used a least one medication classified as potentially risky. However, this proportion dropped to 26% with the modified classification. Living in urban areas and attending the first antenatal care within their first trimester of pregnancy (longer health surveillance) were associated with using 'potentially risky' medications.

CONCLUSION

This study provides rare and valuable information on the current use of drugs among pregnant women in Burkina Faso. Many pregnant women used medications classified as potentially risky. Our findings suggest the need for rational drug prescription and community education to reduce hazardous drug exposure during pregnancy.

Trends in prescription drug use during pregnancy and postpartum in Norway, 2005 to 2015

PURPOSE

To explore trends in use of maternal medication 3 months prior to, during and 3 months after pregnancy.

METHODS

Data on births from the Medical Birth Registry of Norway were linked to the Norwegian Prescription Database, identifying women's use of medications around pregnancy. All women giving birth in Norway during 2005 to 2015 (638 532 singleton births to 414 567 women) were included. Proportions of pregnant women using different medications in association with pregnancy, and annual relative change in medication use during 2005 to 2015, were calculated.

RESULTS

In Norway, 60% of pregnant women used prescription medications during pregnancy (2005-15), increasing from 57% in 2005 to 62% in 2015. The annual relative increase was 0.9% (95% CI: 0.8-1.0). In the first trimester, approximately 17% of the women used medications regarded as potentially teratogenic during 2005 to 2015, increasing from 15% to 19%. Overall, this proportion was higher in the first than in the second (8.9%) and third (8.0%) trimesters, and higher than in the 3 months after pregnancy (14%). The annual relative increase of medications regarded as potentially teratogenic in the first trimester was 2.5% (95% CI: 2.3-2.7).

CONCLUSIONS

The proportion of women using potentially teratogenic medications in the first trimester of pregnancy have increased during the last decade. Clinicians need to be aware of the possibility of pregnancy when prescribing potentially teratogenic medication to women of fertile age and focus this in the consultations. The increasing trends call for the need of routine surveillance of adverse birth outcomes linked to medication use in pregnancy.

[Pharmacokinetics and drug safety of oral infectious disease during pregnancy]

Pregnancy is a time of particular vulnerability in terms of physiologic changes resulting in higher risk of oral infectious diseases. There is emerging evidence showing that irrational dental treatment and drug therapy are associated with adverse pregnancy outcomes, including infant malformation or spontaneous abortion. This article reviews the pharmacokinetics of medications in pregnant women and the fetus and introduces a guideline for drug therapy and common dental drugs used during pregnancy.

Medications and pregnancy: The role of community pharmacists - A descriptive study

Background

Safe use of medications during pregnancy requires a comprehensive understanding of risk-benefit profiles for individual treatments. Pharmacists are supported in this aspect by clinical information agencies (e.g. MotherSafe, a telephone-based teratogen information service) and reference texts. To what extent and for what reasons Australian pharmacists utilise these services/resources are yet unknown. Further, debate on replacement of conventionally defined medication safety in pregnancy categories (A, B1-3, C, D, X) by narratively stated safety evidence may affect pharmacists’ routine practice. This study aimed to gauge pharmacists’ experiences and resource needs in undertaking support roles regarding gestational drug use.

Methods

Semi-structured interviews (audio-recorded or documented using field notes) were performed with community pharmacists in Australia and transcribed verbatim. Inductive thematic analysis was conducted using the NVivo software (Version 11, QSR International).

Results

Data saturation was achieved with 24 interviews. Qualitative data yielded 5 emergent themes: barriers to effective counselling, patient trust, risk perception, role definition and practice support needs. Overall, participants relied on pregnancy categories, were risk averse and cautious in offering advice. Currently available data for unclassified and category B therapeutic agents (limited human data) were deemed inadequate. Reluctance to use the proposed narrative system was also expressed.

Discussion

This study highlights key barriers in the provision of maternal care by pharmacists and the potential tension present if the existing category system is replaced by a narrative one. These need to be addressed through training and development of practice support resources to enhance pharmacists’ skills in evidence-based risk estimation and communication.

Safety profile of medication used during pregnancy: results of a multinational European study

PURPOSE

The present study describes the safety profile of medications used during pregnancy across European countries and examines maternal factors associated with the use of risky medications during pregnancy.

METHODS

This study is based on a multinational, web-based study conducted in 15 European countries from October 2011 to February 2012. Information about maternal demographics, illnesses, and medication use during pregnancy was collected via an electronic questionnaire. Pregnant women and new mothers with a child less than 1-year-old could participate. The Swedish, Australian, and U.S. risk classification systems were used to evaluate medication safety. Descriptive statistics and generalized estimating equation models were used.

RESULTS

A total of 587 medications were reported by the study sample (n = 6657). Sixty-nine percent of the women used medications classified as safe, 28% used medications classified as risky, and 3% used medications with no classification available. Both socio-demographic and medical factors were associated with the use of risky medications during pregnancy. Having a chronic disorder was the factor with the strongest association with the use of risky medications during pregnancy (adjusted odds ratio = 3.99, 95% confidence interval 3.54-4.49).

CONCLUSIONS

The majority of women used medications classified as safe to use during pregnancy. However, a considerable proportion of women still used medications classified as risky. Having a chronic disorder was an important driver for using risky medications. Such use may still be appropriate when considering the woman's underlying condition. Pre-pregnancy counselling is important to ensure safe medication use for both mother and child. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd.