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Camden A, Grandi SM, Lunsky Y, Ray JG, Sharpe I, Lu H, Guttmann A, Tailor L, Vigod S, De Vera MA, Brown HK. Prescription Medication Use in Pregnancy in People with Disabilities: A Population-Based Cohort Study. J Womens Health (Larchmt) 2024. [PMID: 38946624 DOI: 10.1089/jwh.2023.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Background: Individuals with disabilities may require specific medications in pregnancy. The prevalence and patterns of medication use, overall and for medications with known teratogenic risks, are largely unknown. Methods: This population-based cohort study in Ontario, Canada, 2004-2021, comprised all recognized pregnancies among individuals eligible for public drug plan coverage. Included were those with a physical (n = 44,136), sensory (n = 13,633), intellectual or developmental (n = 2,446) disability, or multiple disabilities (n = 5,064), compared with those without a disability (n = 299,944). Prescription medication use in pregnancy, overall and by type, was described. Modified Poisson regression generated relative risks (aRR) for the use of medications with known teratogenic risks and use of ≥2 and ≥5 medications concurrently in pregnancy, comparing those with versus without a disability, adjusting for sociodemographic and clinical factors. Results: Medication use in pregnancy was more common in people with intellectual or developmental (82.1%), multiple (80.4%), physical (73.9%), and sensory (71.9%) disabilities, than in those with no known disability (67.4%). Compared with those without a disability (5.7%), teratogenic medication use in pregnancy was especially higher in people with multiple disabilities (14.2%; aRR 2.03, 95% confidence interval [CI]: 1.88-2.20). Furthermore, compared with people without a disability (3.2%), the use of ≥5 medications concurrently was more common in those with multiple disabilities (13.4%; aRR 2.21, 95% CI: 2.02-2.41) and an intellectual or developmental disability (9.3%; aRR 2.13, 95% CI: 1.86-2.45). Interpretation: Among people with disabilities, medication use in pregnancy is prevalent, especially for potentially teratogenic medications and polypharmacy, highlighting the need for preconception counseling/monitoring to reduce medication-related harm in pregnancy.
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Affiliation(s)
- Andi Camden
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- ICES, Toronto, Canada
| | - Sonia M Grandi
- The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Yona Lunsky
- ICES, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Joel G Ray
- ICES, Toronto, Canada
- Department of Obstetrics and Gynaecology, St. Michaels Hospital, Toronto, Canada
| | | | | | - Astrid Guttmann
- ICES, Toronto, Canada
- Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Lauren Tailor
- The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Simone Vigod
- ICES, Toronto, Canada
- Department of Psychiatry, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- ICES, Toronto, Canada
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Reif S, Mitra M. The Complexities of Substance Use Disorder and People with Disabilities: Current Perspectives. Disabil Health J 2022; 15:101285. [DOI: 10.1016/j.dhjo.2022.101285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/03/2022]
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