An assessment of pregnant women's knowledge and use of the Internet for medication safety information and purchase

Knowledge, attitude, and practice of medication use among pregnant women in Riyadh City: a cross-sectional study

Introduction

Medication use during pregnancy is limited by the scarcity of safety data for many drugs. The use of certain drugs during pregnancy can be teratogenic. Overestimating teratogenic medication risk could have serious consequences from drug non-adherence. Assessing and understanding the knowledge, attitude, and practice of medication use among pregnant women is crucial to optimizing the health of pregnant women and their fetuses.

Methodology

An observational cross-sectional study used convenience and snowball sampling with a self-administered online questionnaire in 562 pregnant women from Riyadh City. The questionnaire used was adapted from previously published surveys. The survey included sections on sociodemographic background, awareness of medication risks, medication use during pregnancy, sources of drug information, and statements from the Beliefs about Medicines Questionnaire (BMQ), both general and pregnancy-specific.

Results

Medication use during pregnancy was reported by 44.7%. The primary source for medication information for the majority was the physician. Over 58% indicated inadequate or inconsistent information about medication from physicians. Additionally, 65.7% confirmed not receiving sufficient or inconsistent information from pharmacists during medication dispensing. The responses to the questionnaire reveal a commendable level of knowledge and positive attitude and practice. However, variations could be found in these responses. Overall, no evident relationships were observed between predictors and responses, except in specific statements that indicated a positive association between beliefs and higher levels of education and youth.

Conclusion

The results suggest a positive knowledge, attitude, and practice level. However, there was hesitancy and a restrictive attitude towards medication during pregnancy. The study identified inadequate education provided by healthcare professionals, thus presenting an area for improvement to enhance the safety and efficacy of medication use during pregnancy.

Medication safety perceptions in China: Media exposure, healthcare experiences, and trusted information sources

OBJECTIVE

Amid ongoing medication safety concerns in China and limited research on public perceptions, this study investigates the correlations between media exposure, healthcare experiences, and individuals' perceptions of medication safety. It also examines individuals' reliance on information sources during safety crises.

METHODS

A multistage stratified random sampling was employed with the gross sample containing 3090 Chinese adults aged 18-60 years. Data were analyzed using multiple linear regression.

RESULTS

Social media exposure was found to negatively correlate with perceptions of current medication safety and its perceived improvement, while exposure to television and print media showed positive correlations. Positive healthcare experiences were associated with improved medication safety perceptions. Among various information sources, healthcare professionals were deemed most trustworthy during medication safety incidents.

CONCLUSIONS

Media exposure and personal healthcare experiences significantly shape individuals' perceptions of medication safety in China, with healthcare professionals playing a crucial role in this context. Practiceimplications: Effective health crisis communication in China needs to be multifaceted, integrating traditional media and social media platforms to disseminate accurate information broadly. Additionally, healthcare professionals should be actively involved in crisis communication. Their role as trusted sources can be leveraged to clarify misconceptions, and reassure the public during medication safety incidents.

What influences consumers' online medication purchase intentions and behavior? A scoping review

Objective: Consumers increasingly buy pharmaceuticals online. No scoping review has been carried out to summarize and synthesize the studies that have identified drivers of consumers' purchase intention and behavior from online pharmacies. Thus, we conducted a scoping review to explore the extent to which prior research has studied consumer purchase intentions and behavior related to online pharmacies, the drivers previously identified to explain consumers' online pharmacy purchase intentions and behavior, and how these antecedents differ between OTC and prescription medications. Then, we identified gaps in the published literature to form a comprehensive theory-based agenda for future research. Methods: We searched PubMed, Web of Science, and Scopus to retrieve relevant studies published in English in peer-reviewed journals. The search strategy identified forty-eight eligible studies. Results: We identified twelve types of factors influencing purchase intentions and behaviors from online pharmacies: demographics, convenience, availability, price, evaluations of the purchase environment, information sources, internet usage, prior experience, perceived risk, health insurance, privacy, and product. Our analysis also revealed differences between OTC and prescription medications in drivers of purchase intentions and behaviors. Conclusion: While demographic factors tended to be the most often measured influences on intentions and behavior, their role was generally inconsistent, with many contradictory results. However, other factors (e.g., convenience, availability, lower prices, and favorable evaluations toward the purchase environment) more consistently enhanced online medication purchase intentions and behavior. An extensive agenda for future research is advanced.

Using a patient-centred composite endpoint in a secondary analysis of the Control of Hypertension in Pregnancy Study (CHIPS) Trial

BACKGROUND

Clinical trials commonly use multiple endpoints to measure the impact of an intervention. While this improves the comprehensiveness of outcomes, it can make trial results difficult to interpret. We examined the impact of integrating patient weights into a composite endpoint on the interpretation of Control of Hypertension in Pregnancy Study (CHIPS) Trial results.

METHODS

Outcome weights were extracted from a previous patient preferences study in pregnancy hypertension (N = 183 women) which identified (i) seven outcomes most important to women (taking medication, severe hypertension, pre-eclampsia, blood transfusion, Caesarean, delivery < 34 weeks, and baby born smaller-than-expected) and (ii) three preference subgroups: (1) 'equal prioritizers', 62%; (2) 'early delivery avoiders', 23%; and (3) 'medication minimizers', 14%. Outcome weights from the preference subgroups were integrated with CHIPS data for the seven outcomes identified in the preference study. A weighted composite score was derived for each participant by multiplying the preference weight for each outcome by the binary outcome if it occurred. Analyses considered equal weights and those from the preference subgroups. The mean composite scores were compared between trial arms (t-tests).

RESULTS

Composite scores were similar between trial arms with the use of equal weights or those of subgroup (1) (95% confidence intervals [CIs]: - 0.03, 0.02; p > 0.50 for each). 'Tight' control was superior when using subgroup (2) weights (95% CIs: 0.002, 0.07; p = 0.03), and 'less-tight' control was superior when using subgroup (3) weights (95% CIs: - 0.11, - 0.04; p < 0.01).

CONCLUSIONS

Evidence-based recommendations for 'tight' control are consistent with most women's preferences, but for a sixth of women, 'less-tight' control is more preference consistent. Depending on patient preferences, a single trial may support different interventions. Future trials should specify component weights to improve interpretation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01192412.

Identifying target areas of medicines information efforts to pregnant and breastfeeding women by reviewing questions to SafeMotherMedicine: A Norwegian web-based public medicines information service

BACKGROUND

Online information about safety of medications during pregnancy and breastfeeding is shown to be conflicting, resulting in anxiety and abstaining from use. The aim of this study was to characterize questions to SafeMotherMedicine, a web-based medicines information service for pregnant and breastfeeding women, to identify target areas that could guide subsequent development of medicines information directed at pregnant and breastfeeding women.

METHODS

The SafeMotherMedicine database contains all questions received through the web-based service and their corresponding answers. A retrospective database analysis of questions received from January 2016 to September 2018 was performed, using descriptive statistics.

RESULTS

A total of 11 618 questions were received including 5 985 questions (51.5%) concerning pregnancy, 4 878 questions (42.0%) concerning breastfeeding, and 755 questions (6.5%) concerning both conditions. The medications in question represented all therapeutic groups with paracetamol (7.0%), ibuprofen (4.1%), cetirizine (3.3%), desloratadine (3.2%) and meclizine (2.8%) being the top five. The 20 medications most frequently asked about for either pregnancy, breastfeeding or both pregnancy and breastfeeding, constituted half of all questions and were used to identify target areas. These included both symptomatic relief of common complaints, such as pain, nausea, and rhinitis, as well as treatment of chronic conditions such as allergy, psychiatric disorders, and asthma. Analysis of a subset of questions showed that most of these questions were asked before use of medications in a current pregnancy (49%) or during breastfeeding (72%). The questions concerned use of medications in all stages of pregnancy and breastfeeding. For 81.6% of the questions concerning pregnancy, and for 84.2% of the questions concerning breastfeeding, information of no or low risk for the foetus or the breastfed infant was provided by SafeMotherMedicine.

CONCLUSIONS

We found that target areas for medicines information directed at pregnant and breastfeeding women included both symptomatic relief of common complaints as well as treatment of chronic conditions. The questions concerned a wide range of medications and involved use in all stages of pregnancy and breastfeeding. Our findings indicate that developing medicines information addressing the identified target areas will meet the information need for a large proportion of this patient group.

Women's reasons for taking complementary medicine products in pregnancy and lactation: Results from a national Australian survey

BACKGROUND

and purpose: Pregnant and breastfeeding women commonly use complementary medicine products (CMPs), including dietary supplements and herbal medicines. This study investigated women's reasons for use.

MATERIALS AND METHODS

A national, cross-sectional, online survey conducted between July-September 2019 investigated reasons for CMP use during pregnancy and lactation. Australian women who were currently pregnant and/or breastfeeding participated. Data analysis included descriptive statistics, Chi-square and principal component analyses.

RESULTS

Of the 810 women surveyed (n = 354 pregnant; n = 456 breastfeeding), most reported prior CMP use and felt that CMPs had been beneficial to maintaining and optimising their own and their children's health. However, when ill, they preferred medicines prescribed by doctors or pharmacists. Perceived benefits to their unborn or breastfeeding babies' health and their own health (both cohorts), the health of their pregnancy (pregnant participants), and benefits to the breastfeeding process and breastmilk supply (breastfeeding participants) were important reasons for women's CMP use.

CONCLUSION

Women's reasons for CMP use centred on perceived benefits to their own health and the health of their babies. Women's prior positive experiences with CMP use, combined with preferences for pharmaceutical use when ill, indicates their use of CMPs can be considered complementary, rather than alternative, to biomedical health care.

Twenty-year trends in the use of anti-seizure medication among pregnant women in the Netherlands

BACKGROUND

Anti-seizure medications (ASMs) are used to treat conditions such as epilepsy and bipolar disorder. Some of these drugs are associated with an increased risk of congenital malformations and adverse developmental outcomes.

OBJECTIVES

To examine trends in use of ASMs among pregnant women in the Netherlands according to medication safety profile.

METHODS

Using population-based data from the PHARMO Perinatal Research Network, we assessed trends in use of ASMs among pregnant women in the Netherlands between 1999 and 2019, stratified by medication safety profile. Individual treatment patterns were also assessed.

RESULTS

In total, 671,709 pregnancies among 446,169 women were selected, of which 2405 (3.6 per 1000) were ASM-exposed. Over the study period, a significant increase was observed for use of known safest ASMs (0.7-18.0 per 10,000 pregnancies) as well as for those with uncertain risk (5.3-13.4 per 10,000 pregnancies). Use of ASMs with higher risk of congenital malformations decreased significantly (24.8-14.5 per 10,000 pregnancies), except for topiramate (0-6.7 per 10,000 pregnancies). Switches between ASM safety risk categories before and during pregnancy were uncommon; women rather discontinued treatment or switched within the same category. There was no clear change for the proportion using polytherapy during pregnancy (12% overall), however a non-significant trend toward inclusion of known safest ASMs was observed over time (1.9-3.6%).

CONCLUSIONS

Over the last two decades, there has been an increase in use of known safest ASMs among pregnant women, together with a trend toward newer ASMs with uncertain risk. Only a small proportion of women switched to a safer alternative before or during pregnancy. Altogether, this highlights the need for an expansion of ASM risk knowledge and communication to healthcare providers and women of reproductive age to improve preconception counseling.

Analysis of Influencing Factors of Acute Medication Poisoning in Adults in Emergency Department of Our Hospital from 2016 to 2019 and Observation of Curative Effect of Optimizing Emergency Procedures

Objective. This study analyzed the influencing factors of acute medication poisoning in adults in the emergency department of our hospital from January 2016 to December 2019 and observed the curative effect of optimizing emergency procedures on adult acute medication poisoning. Our results showed that, among all acute drug poisoning patients, the most common poisoning drug was sleeping pills (24.22%), followed by painkillers (20.31%) and antipsychotics (16.41%). Education level, drug category, drug source, drug dosage, unknown drug composition, and medication side effect were all influencing factors of acute drug poisoning. High school education level or below, self-purchasing medicine, medication overdose, unknown drug composition, and medication side effect were the risk factors of acute medication poisoning. In addition, after the nursing management of optimizing emergency procedures for this type of patients, the rescue time, observation time, and hospital stay of the patients had been shortened, the incidence of complications was low, the rescue success rate was high, and the clinical application effect was good.

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.

Knowledge, Information Sources, and Institutional Trust of Patients Regarding Medication Use in Pregnancy: A Systematic Review

Objective: The objective of our study is to characterize the knowledge, information sources, and institutional trust of patients regarding medication use in pregnancy. Materials and methods: We conducted a review of three databases: MEDLINE, EMBASE, and CINAHL. We included observational studies and knowledge assessments that examined the knowledge, attitudes, beliefs or information sources of pregnant patients related to medication use during pregnancy. Extraction was completed by two independent reviewers, outcomes were summarized descriptively, and appraisal was conducted. Results: Of the 1359 search results, 34 studies met inclusion criteria. Thus, our systematic review encompasses the beliefs of 11,757 pregnant participants. In most studies, participants described apprehension regarding potential risks to the fetus and the inadequacy of safety information. Across the 23 knowledge assessments, the majority of studies reported patient misconceptions about prescription medication in pregnancy. The most preferred information source was a healthcare provider. However, many participants expressed frustration, mistrust, and skepticism regarding physician knowledge. A common source of mistrust was due to perceived physician self-interest as well as a lack of education tailored to pregnancy. Consequently, informal sources of information were also popular. Conclusion: There is a need to improve the health literacy and trust among pregnant patients regarding drug prescribing. There are modifiable risk factors for mistrust that require further attention.

Online information discrepancies regarding safety of medicine use during pregnancy and lactation: an IMI ConcePTION study

Background: Inconsistencies in information on safety of medicine use during pregnancy and lactation can result in sub-optimal treatment for pregnant and lactating women, risks to the fetus or child and unnecessary weaning off breastfeeding. The objective of this study was to analyze information discrepancies regarding medicine use during pregnancy and lactation between on-line sources for patients and health care professionals (HCPs) in four European languages.Research design and methods: The medicines analyzed were ibuprofen, ondansetron, olanzapine, fingolimod, methylphenidate and adalimumab. Recommendations were classified into different data source categories, for patients and for HCPs, and compared between the data source categories for each medicine and language.Results: For patients, 11/24 (46%) and 4/24 (17%) comparisons of the pregnancy and lactation recommendations, respectively, were consistent between all sources. The corresponding figures for HCP-sources were 13/24 (54%) and 5/24 (21%). Regulatory sources had generally more restrictive recommendations. Teratology Information Services (TIS) centers' recommendations for medicine use during pregnancy and lactation were consistent in 25/27 (93%) and 15/22 (68%) of cases respectively.Conclusion: Discrepancies between online information sources regarding medicine use during pregnancy and lactation are common, especially for lactation. TIS centers recommendations were more aligned. Additional work is needed to harmonize information within and between countries to avoid conflicting messages.

The effect of the Internet on decision-making during pregnancy: a systematic review

The purpose of this review is to explain how the Internet affects decision-making in pregnancy. A systematic review was carried out in accordance with the guidelines developed by the National Institute of Health Research at York University. The PubMed, EBSCOhost, Ulakbim Medical Database, Turkish Medline, Web of Science, and Scopus databases were scanned. Three keywords in the titles, abstracts, and keywords of the articles were searched for in the Medical Subject Headings: "Pregnancy," "Decision-making," and "Internet." A total of 1143 articles were found in the first screening. Duplicate articles were removed. The remaining articles were reviewed according to the inclusion criteria. Only articles about healthy pregnant women were accessed, and only full-text research articles published in English were used. Seventeen articles met the inclusion criteria. The sample size varied between 9 and 7092. Most studies reported that pregnant women use the Internet as a source of information about pregnancy. Pregnancy, development of the fetus, labor, neonatal health, and nutrition were the subjects most researched. It was found that women with a higher education, who were young, nulliparous, and primigravid, looked for more information on the Internet. The Internet affects decisions about the type of delivery, drug use in pregnancy, and physical activity. Using the Internet had a positive effect on the decision-making processes of pregnant women, increased their awareness, and had a visible effect on this process.

Internet and decision-making regarding health among pregnant woman: cross-cultural adaptation of a questionnaire for use in Brazil

The aim of this study was to translate and cross-culturally adapt the Women's Use of the Internet in Pregnancy Questionnaire (WUIPQ) to Brazilian Portuguese and analyze the psychometric properties of the Preparation for Decision Making Scale (PDMS). This study consisted of the following steps: translation, synthesis, back-translation, evaluation by the author of the original questionnaire, review by the panel of experts, and pretest of the WUIPQ. For such, Brazilian pregnant women and mothers who were members of Facebook groups participated in the study. We measured test-retest reliability as well as internal consistency and performed confirmatory factor analysis (CFA) of the B-PDMS. In the pretest, 88.14% of the participants considered the items of the B-WUIPQ to be clear and pertinent, and 84.09% rated the sequence and organization of the questionnaire as excellent/good. The intraclass correlation coefficient and Cronbach's alpha coefficient for the B-PDMS were 0.850 (95%CI: 0.791-0.899) and 0.91, respectively. CFA revealed factor loadings higher than 0.70 for most items, with a comparative fit index of 0.989, Tucker-Lewis index of 0.984, and root mean square error of approximation of 0.08 (95%CI: 0.06-0.09). The B-WUIPQ presented cross-cultural adapted, and the B-PDMS demonstrated satisfactory psychometric proprieties to Brazilian pregnant women.

Pregnancy-Related Information Seeking in Online Health Communities: A Qualitative Study

Pregnancy often imposes risks on women's health. Consumers are increasingly turning to online resources (e.g., online health communities) to look for pregnancy-related information for better care management. To inform design opportunities for online support interventions, it is critical to thoroughly understand consumers' information needs throughout the entire course of pregnancy including three main stages: pre-pregnancy, during-pregnancy, and postpartum. In this study, we present a content analysis of pregnancy-related question posts on Yahoo! Answers to examine how they formulated their inquiries, and the types of replies that information seekers received. This analysis revealed 14 main types of information needs, most of which were "stage-based". We also found that peers from online health communities provided a variety of support, including affirmation of pregnancy, opinions or suggestions, health information, personal experience, and reference to health providers' service. Insights derived from the findings are drawn to discuss design opportunities for tailoring informatics interventions to support consumers' information needs at different pregnancy stages.

Evaluation of online counselling services based on Turkish web-based pharmacy care setting: A retrospective observational study

AIMS OF THE STUDY

To determine the types of online pharmacy care services provided by the clinical pharmacists regarding identification of medication-related problems, provision of counselling services for health and disease conditions alongside medications' counselling for patients seeking online consultation about health, medication and lifestyle concerns based on Turkish web-based pharmacy care setting(WPCS).

METHODS

A retrospective, descriptive cohort study carried out on patients during their online visiting of Turkish WPCS seeking consultation for diverse kinds of concerns from September 2015 to March 2016. Patients' health and medication data were gathered for assessment of health-, medication- and lifestyle-related concerns. Descriptive analysis and Chi square test were used to analyse study data. Study outcomes included personalised online pharmacy care services regarding identification of medication-related problems, counselling services for health and disease conditions and medications' counselling alongside associations with counselling-related concerns by the WPCS.

RESULTS

A total of 350 participants enrolled in this study and the majority of them were women (62.6%). Dermatological and gynaecological conditions represented the majority of disease conditions (51.4%, 44.6%), respectively. Within 1 year, 63.7% of the study participants visited the Turkish WPCS more than three times. Medication- and health-related concerns were reported by 90.8% and 68.3% of the study participants, respectively. Medication side effects (44.1%) and an inappropriate medication timing (31.4%) were the major medication-related problems identified. A total of 477 different counselling services regarding health conditions and 990 counselling regarding medications were provided by the clinical pharmacist through the Turkish WPCS.

CONCLUSION

The WPCS could be considered as an additional option for the clinical pharmacist to provide care services regarding identification of medication-related problems, provision of counselling about health and disease conditions alongside different medication counselling to improve health conditions and proper pharmacotherapy management.

Experiences of pregnant mothers using a social media based antenatal support service during the COVID-19 lockdown in the UK: findings from a user survey

OBJECTIVES

The COVID-19 pandemic has seen unprecedented restrictions on face-to-face healthcare encounters. This has led to an increase in the use of online healthcare resources by service users. Pregnant women have always been a group particularly motivated to seek out information online. The objective of this study was to explore the experiences of mothers who were using an existing National Health Service social media based antenatal support service during the early stages of the UK COVID-19 lockdown.

DESIGN

A short online survey with four closed questions (scale response) and one open-ended free-text question was given to pregnant women who were using the online service 3 weeks after the start of the UK lockdown. Descriptive statistics are used to present the closed question data. Thematic analysis was applied to the free-text responses.

RESULTS

320 women were sent the survey. 156 completed it (49% response rate). Participants provided information relating to frequency of use, information access, relative level of antenatal care and ease of contact. 105 (66%) participants completed the open-ended free-text question. Key themes to emerge related to: (1) information provision and verification; (2) managing and reducing feelings of isolation; (3) service specific issues, including crisis adaptations; and (4) impact on routine care.

CONCLUSIONS

The study suggests that that pregnant mothers found a social media based approach well positioned to provide antenatal care and support during the COVID-19 pandemic.

Informação sobre benzodiazepínicos: o que a internet nos oferece?

Resumo Este trabalho analisou a qualidade da informação veiculada na internet sobre 4 benzodiazepínicos amplamente utilizados no Brasil: alprazolam, bromazepam, clonazepam e diazepam. Essa escolha se justifica pelo fato desses medicamentos serem amplamente utilizados, poderem gerar dependência química e a internet ser importante fonte de informação sobre eles. Foram analisados 20 sites para cada medicamento. Mais da metade (56,3%) dos sites foram classificados como deficientes ou muito deficientes. Os problemas mais frequentes foram a ausência da descrição do responsável pelo sítio (60%), informação incompleta (62,5%), ausência de contato para informação adicional (45%) e da última data da atualização (82%). Os resultados reforçam a preocupação com a qualidade da informação em saúde veiculada na internet, já apontada pela literatura, e a necessidade de adoção de critérios mínimos de qualidade para esta informação.

A Qualitative Study of Pregnant Women's Perspectives on Antibiotic Use for Mom and Child: Implications for Developing Tailored Health Education Interventions

The overutilization of antibiotics during pregnancy and early life are associated with adverse health outcomes for mothers and infants. In this study, we explored pregnant women’s opinions and concerns of antibiotics and how perceptions may affect their health-related decision-making. We conducted 18 in-depth, semi-structured interviews with pregnant women and used the Health Belief Model (HBM) as a framework to analyze the data. We found that mothers generally understood the benefits of antibiotics and were aware that antibiotics are clinically effective for treating bacterial infections. Importantly, perceived barriers related to antibiotic use included concerns regarding the impact of antibiotics on breastfeeding efficacy, microbial health, and societal factors such as antimicrobial resistance. The prescription of antibiotics by a healthcare provider was a cue to action for women, as they trusted providers to recommend medications that were safe for them and their infants. Overall, mothers shared that receiving education on the effects of antibiotics would improve their self-efficacy and decision-making surrounding the use of antibiotics for treating illness. Implications for tailored perinatal health education interventions to enhance antibiotic use, knowledge, and decision-making are discussed.

The impact of pregnant women's health literacy on their health-promoting lifestyle and teratogenic risk perception

This study was conducted to determine pregnant women's health literacy level and its effect on health-promoting lifestyle and perception of teratogenic risk related to medicine. The sample of the study consisted of 326 pregnant women. Women with high health literacy have more health-promoting lifestyles and lower teratogenic risk perceptions toward using antidepressants and influenza immunization during pregnancy. This study gives baseline data on health literacy and teratogenic risk perception of medicine usage during pregnancy in Turkish women.

Use of Social Media for Pharmacovigilance Activities: Key Findings and Recommendations from the Vigi4Med Project

The large-scale use of social media by the population has gained the attention of stakeholders and researchers in various fields. In the domain of pharmacovigilance, this new resource was initially considered as an opportunity to overcome underreporting and monitor the safety of drugs in real time in close connection with patients. Research is still required to overcome technical challenges related to data extraction, annotation, and filtering, and there is not yet a clear consensus concerning the systematic exploration and use of social media in pharmacovigilance. Although the literature has mainly considered signal detection, the potential value of social media to support other pharmacovigilance activities should also be explored. The objective of this paper is to present the main findings and subsequent recommendations from the French research project Vigi4Med, which evaluated the use of social media, mainly web forums, for pharmacovigilance activities. This project included an analysis of the existing literature, which contributed to the recommendations presented herein. The recommendations are categorized into three categories: ethical (related to privacy, confidentiality, and follow-up), qualitative (related to the quality of the information), and quantitative (related to statistical analysis). We argue that the progress in information technology and the societal need to consider patients' experiences should motivate future research on social media surveillance for the reinforcement of classical pharmacovigilance.

Dutch trends in the use of potentially harmful medication during pregnancy

Aims

Recent population‐based data on drug utilization around pregnancy are lacking. This study aims to examine the prevalence of drug exposure in the Netherlands during the preconception, pregnancy and postpartum periods, with special emphasis on trends of potentially harmful medication over the years.

Methods

A population‐based study was conducted using records from the PHARMO Perinatal Research Network. From 1999 to 2017, the proportion of pregnancies during which women used any medication or potentially harmful medication was assessed, overall and stratified by timing of exposure relative to pregnancy and by the year of delivery.

Results

Overall, 357 226 (73%) and 166 484 (34%) of 487 122 selected pregnancies were exposed to any and potentially harmful medication, respectively. Among these 487 122 pregnancies, preconception prevalence for use of potentially harmful medication was 43%, 24% during the first trimester, 19% during the second, 16% during the third, and 45% postpartum. A declining trend was observed for exposure to any medication, from 84% in 1999 to 68% in 2017. No clear changes were observed over time for the proportion of pregnancies exposed to potentially harmful medication.

Conclusions

Our study shows that the use of potentially harmful medication was high over the last two decades. Although there was a declining trend over the years in overall medication use, during a steady one‐third of pregnancies, women used potentially harmful medication. Our findings highlight the need for an increased sense of urgency among both healthcare providers and women of reproductive age regarding potential risks associated with pharmacological treatment during pregnancy.

Midwife-moderated social media groups as a validated information source for women during pregnancy

BACKGROUND

Widespread use of the internet has fundamentally altered the way people access health information and communicate with health providers. Pregnant women are a group who are particularly highly motivated to seek out information online. However, where mothers actually obtain their information, who they trust to supply it, and whether or not it actually fulfils their needs is often unclear. This paper examines the experiences of women accessing advice and information on pregnancy and childbirth through a dedicated social-media platform, mediated by qualified midwives. The study formed part of a larger research project that focussed on professionally moderated online learning in maternity care, and the role of online communities. This paper reports on aspects of midwife mediated information provision in the context of these online communities.

METHODS

Two secret (i.e. private / invitation only) Facebook groups were created. Both groups were moderated by 2 qualified midwives. One group had 17 mothers and the other 14 mothers. Both groups ran for 35 weeks.

DATA AND ANALYSIS

The data included the written and spoken words of group participants and midwife-moderators in i) face-to-face (n = 4) and online (n = 4) post-intervention focus groups; ii) one-to-one interviews with group participants and midwife moderators (n = 24); iii) the complete corpus of text-based interaction across both groups; iv) a sub-set of private message sessions (n = 24) between individual participants and midwife-moderators. Thematic analysis was applied to the combined dataset.

FINDINGS

Participants found engagement with midwives and other pregnant women via a social media group convenient and accessible. The groups provided a safe space for the sharing and validation of maternity relevant information. Members trusted their midwife-moderators to ensure information was reliable. For many members, the group became the primary source of pregnancy related information.

CONCLUSION

Midwife-mediated social media groups offer a highly effective way of providing individualised information provision and social support for pregnant woman. Access to a group can also significantly impact on perceptions of relational continuity.

Patient Preferences and Decisional Needs When Choosing a Treatment Approach for Pregnancy Hypertension: A Stated Preference Study

The Hypertension Canada 2018 clinical guidance for pregnancy hypertension recommends antihypertensive therapy for raised blood pressure in pregnancy to a target diastolic blood pressure (BP) of 85 mm Hg (ie, "tight" control). Although evidence shows this approach reduces the incidence of severe maternal hypertension without increasing risk to the baby, we do not know how pregnant women feel about this approach, particularly as they are generally medication averse. An online survey assessed pregnant women's preferences for management of pregnancy hypertension and explored decisional needs. The survey included information provision and knowledge assessment, a preference elicitation task, and a decisional needs assessment. Survey responses were analysed descriptively, by latent class analysis to identify treatment priority subgroups, and by logistic regression to assess predictors of treatment preference. For the 183 pregnant respondents, 3 treatment priority subgroups were identified, with most respondents expressing equal prioritization of treatment outcomes and components (eg, taking medication). Participants who preferred tight control (49%) were more often white (odds ratio [OR]: 2.38; 95% confidence interval [CI]: 1.18-4.55), with a university education/professional qualification (OR 1.95; 95% CI: 1.02-3.7), and had greater knowledge about pregnancy hypertension and pregnancy complications (OR 1.37; 95% CI: 1.15-1.65). Participants reported diverse decisional needs, but most preferred to make final treatment decisions themselves (70%), with (48%) or without (22%) physician input. The diversity of priorities, preferences, and decisional needs for management of pregnancy hypertension identified in this study emphasises the importance of an individualized approach to treatment recommendations.

Pregnancy-Related Information Seeking and Sharing in the Social Media Era Among Expectant Mothers: Qualitative Study

Background

Social media has become the most popular communication tool used by Chinese citizens, including expectant mothers. An increasing number of women have adopted various forms of social media channels, such as interactive websites, instant messaging, and mobile apps, to solve problems and obtain answers to queries during pregnancy. Although the use of the internet by pregnant women has been studied extensively worldwide, limited research exists that explores the changing social media usage habits in China, where the 1 child policy ended in 2015.

Objective

This study aimed to (1) present the status quo of pregnancy-related information seeking and sharing via social media among Chinese expectant mothers, (2) reveal the impact of social media usage, and (3) shed light on pregnancy-related health services delivered via social media channels.

Methods

A qualitative approach was employed to examine social media usage and its consequences on pregnant women. A total of 20 women who had conceived and were at various stages of pregnancy were interviewed from July 20 to August 10, 2017. Thematic analysis was conducted on the collected data to identify patterns in usage.

Results

Overall, 80% (16/20) of participants were aged in their 20s (mean 28.5 years [SD 4.3]). All had used social media for pregnancy-related purposes. For the seeking behavior, 18 codes were merged into 4 themes, namely, gravida, fetus, delivery, and the postpartum period; whereas for sharing behaviors, 10 codes were merged into 4 themes, namely, gravida, fetus, delivery, and caretaker. Lurking, small group sharing, bad news avoidance, and cross-checking were identified as the preferred patterns for using social media. Overall, 95% (19/20) of participants reported a positive mental impact from using social media during their pregnancy.

Conclusions

It is indisputable that social media has played an increasingly important role in supporting expectant mothers in China. The specific seeking and sharing patterns identified in this study indicate that the general quality of pregnancy-related information on social media, as well as Chinese culture toward pregnancy, is improving. The new themes that merge in pregnancy-related social media use represent a shift toward safe pregnancy and the promotion of a more enjoyable pregnancy. Future prenatal care should provide further information on services related to being comfortable during pregnancy and reducing the inequality of social media–based services caused by the digital divide.

Social media monitoring on the perceived safety of medication use during pregnancy: A case study from the Netherlands

Aims

An increasing number of women trust the Internet for information about medication safety during pregnancy. This study aimed to evaluate the availability and accuracy of social media content on the perceived safety of medication use in pregnancy.

Methods

We performed a systematic search of posts related to medication safety during pregnancy in the Dutch language published on social media, blogs and forums between May 2011 and April 2016 using Coosto, a tool for social media monitoring. The perceived safety in the posts was compared with the Dutch Teratology Information Service (TIS) safety classifications.

Results

We included 1224 online posts, which described 1441 scenarios about medication safety in pregnancy. A total of 820 (57%) scenarios were in line with the TIS classification. Incorrect perception was higher for prescription medication compared to medication available over‐the‐counter (60 vs 25%). Furthermore, the safety classification of medications with a TIS classification on strict indication or second‐line drugs (93%) and medications with insufficient knowledge on their safety during pregnancy (76%) was more likely to be incorrectly perceived by the public compared to medications with the TIS classification safe (24%).

Conclusions

Social media monitoring may be useful for surveillance of potentially unsafe use of medications in pregnancy. Many social posts related to medication safety during pregnancy provide inaccurate information. As this information may affect women's perceptions and decisions, accurate communication between healthcare providers and pregnant women regarding the benefits and risks of medications is vital.

Community pharmacist counseling in early pregnancy-Results from the SafeStart feasibility study

Background

Community pharmacists are available to counsel women in early pregnancy, but no studies have assessed the feasibility of such a service.

Objective

To test the feasibility of a pharmacist consultation in early pregnancy and to inform the design of a definitive trial.

Setting

Six community pharmacies in Norway from Oct. to Dec. 2017.

Method

We evaluated recruitment approaches and an automatic data preprocessing system (ADPS) to enroll, assign participants, and distribute questionnaires. Women (≥18 years) in early pregnancy were eligible for inclusion. Participants were assigned to a pharmacist consultation (intervention group) or standard care (control group). The intervention aimed to address each woman’s concerns and needs regarding medications and ailments in pregnancy, and was documented on a standard form. The women’s acceptability of the intervention was measured by a questionnaire.

Main outcome measures

Appropriate recruitment approaches, workflow of the ADPS, and women’s acceptability of the intervention.

Results

Of the 35 participants recruited, 19 were recruited through Facebook. The ADPS worked well. Treatment of nausea and vomiting (NVP) (10/11) and general information about medications (8/11) were frequently discussed during the consultations (n = 11). The women reported high satisfaction with the consultation. Having the option of telephone and follow-up consultations was important to the women.

Conclusion

It is feasible to provide community pharmacist consultations in early pregnancy. In a definitive study, the consultations should focus on NVP and general medication use and further explore social media as a recruiting tool. Both in-pharmacy and telephone consultations should be offered to deliver the intervention.

Perceptions of medicine use among pregnant women: an interview-based study

Background When women are in a condition that requires medicines during pregnancy they have to balance the health benefits of the medical treatment against the potential risk of harming their unborn child. Too high teratogenic risk perceptions among pregnant women can lead them to stop taking the medicine, worsening the symptoms for the mother and even harming their foetus. Many women today who use over-the-counter and prescribed medicines have been shown to change their medical behaviour when they become pregnant. Objective To explore in depth the perceptions of medication use among women during their pregnancy. Setting The Capital Region of Denmark. Methods Participants were recruited from social network groups on Facebook and from participants in lectures and antenatal classes for pregnant women in two hospitals. Two focus groups interviews and three individual semi-structured interviews were conducted. The interview guides were based on existing literature and relatively unstructured, with an emphasis on open-ended questions. Interview transcripts were analysed using the phenomenological approach of meaning condensation. Main Outcome measure Pregnant women's' perceptions of medicine including aspects related to their safety feeling of medicines and perceived support from health care professionals. Results The women believed that it is less safe to take medicines during pregnancy, largely due to the risk of the child getting a disease in the future, but also due to the risk of malformation. Lack of clinical tests and uncertainty about how the unborn child reacts to medications were reported causes of these concerns. Most participants were concerned about using medicines and avoided them if possible, including over-the counter medicines. Conversations with physicians had a calming effect although the physicians appeared to be unclear in their guidance regarding dietary supplements. Some women received conflicting information on the Internet. Several suggestions were made about how to reduce uncertainties about the safety of taking medicines during pregnancy. Conclusion Many pregnant women are concerned about how to use medicines. To reduce these concerns and ensure the appropriate use of medicines during pregnancy, initiatives are needed to strengthen evidence-based advice from health care professionals, especially during the first trimester.

Beliefs about medicines and information needs among pregnant women visiting a tertiary hospital in Belgium

PURPOSE

To explore beliefs about medicines and information needs among pregnant women visiting a tertiary hospital in Belgium and to identify patient characteristics associated with beliefs about medicines.

METHODS

A cross-sectional study was performed at the outpatient obstetrics clinic of the University Hospital Leuven, Belgium, between December 2016 and March 2017. All pregnant women ≥ 18 years were invited to complete a web survey. The survey consisted of general and pregnancy-specific statements of the "Beliefs about Medicines" questionnaire and questions about information needs. Descriptive statistics, chi-square tests, Fisher's exact tests, and multinomial logistic regression were used to analyze the findings.

RESULTS

In total, 372 pregnant women participated. Most women showed positive attitudes towards medicines in general. However, almost 90% of women agreed to have a higher threshold to use medicines during pregnancy compared with non-pregnant situations. Likewise, 40% preferred natural remedies during pregnancy. Education in healthcare and education level were the main determinants associated with beliefs, with highly educated women showing a higher threshold to use medicines during pregnancy (p = 0.005). Most women searched online for pregnancy-related information (85%) and for information about medicines (74%). However, less than one-third discussed online-retrieved information with healthcare professionals (HCPs).

CONCLUSIONS

Pregnant women visiting a tertiary hospital in Belgium showed a higher threshold to use medicines during pregnancy compared with non-pregnant situations and had high information needs, including for information about medicines during pregnancy. HCPs should be aware of women's individual beliefs, guide them towards reliable websites, and discuss online-retrieved information during counseling.

An analysis of online pregnancy message boards: Mother-to-mother advice on medication use

PROBLEM AND BACKGROUND

Psychotropic medication use is increasingly common among pregnant women. Many women solicit information from other mothers about the safety of these medications for use during pregnancy, yet little is known about the specific advice they receive.

AIM

The purpose of the current study was to examine the type of feedback women receive on a popular internet message board about psychotropic medication use during pregnancy.

METHODS

A modified Consensual Qualitative Research approach was used to analyze 1728 comments posted by Babycenter.com users about the safety of the use of six common psychotropic medications during pregnancy. Researchers analyzed the comments for overall themes and core ideas.

FINDINGS

Results found that comments were comprised of six themes: (1) Personal Anecdotes, (2) Suggesting Alternative Solutions, (3) Directives, (4) Judgement, (5) Social Support, (6) Skepticism & Mistrust, and (7) Risks vs. Benefits. While many comments conveyed emotional support, or encouraged women to seek professional advice, others contained inaccurate and/or contradictory information, or harsh criticism.

CONCLUSION

Given that the decision about the use of medication during pregnancy has implications for the health of the mother and fetus, it is important for care providers to be aware of what feedback women may receive from this source. Providers should address questions and concerns that women have about safety of these medications and recognize how the social context of the internet impacts the emotional health of pregnant women faced with these decisions.