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de Castro CT, Leal LF, Ramos DDO, Santana JDM, Cordeiro RC, Rivemales MDCC, de Araújo EM, da Silva CAL, Pereira M, dos Santos DB. Racial Disparities in Medication Use During Pregnancy: Results from the NISAMI Cohort. J Multidiscip Healthc 2024; 17:2755-2775. [PMID: 38855020 PMCID: PMC11162620 DOI: 10.2147/jmdh.s455378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/29/2024] [Indexed: 06/11/2024] Open
Abstract
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.
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Affiliation(s)
| | - Lisiane Freitas Leal
- Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, Quebec, Canada
| | | | - Jerusa da Mota Santana
- Center for Health Sciences, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | - Rosa Cândida Cordeiro
- Center for Health Sciences, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
- Postgraduation Program in Health for the Black and Indigenous Population, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | - Maria da Conceição Costa Rivemales
- Center for Health Sciences, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
- Postgraduation Program in Health for the Black and Indigenous Population, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | | | | | - Marcos Pereira
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Djanilson Barbosa dos Santos
- Center for Health Sciences, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
- Postgraduation Program in Health for the Black and Indigenous Population, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
- State University of Feira de Santana, Feira de Santana, Bahia, Brazil
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OUP accepted manuscript. Toxicol Sci 2022; 187:80-92. [DOI: 10.1093/toxsci/kfac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lutz BH, Miranda VIA, Silveira MPT, Dal Pizzol TDS, Mengue SS, da Silveira MF, Domingues MR, Bertoldi AD. Medication Use among Pregnant Women from the 2015 Pelotas (Brazil) Birth Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E989. [PMID: 32033282 PMCID: PMC7037701 DOI: 10.3390/ijerph17030989] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/26/2020] [Accepted: 01/29/2020] [Indexed: 11/16/2022]
Abstract
Background: Medication use during pregnancy is a common practice that has been increasing in recent years. The aim of this study is to describe medication use among pregnant women from the 2015 Pelotas (Brazil) Birth Cohort Study. Methods: This paper relies on a population-based cohort study including 4270 women. Participants completed a questionnaire about the antenatal period, including information about medication use. We performed descriptive analyses of the sample and the medications used and adjusted analyses for the use of medications and self-medication. Results: The prevalence of medication use was 92.5% (95% CI 91.7-93.3), excluding iron salts, folic acid, vitamins, and other minerals. The prevalence of self-medication was 27.7% (95% CI 26.3-29.1). In the adjusted analysis, women who had three or more health problems during pregnancy demonstrated higher use of medicines. Self-medication was higher in lower income groups and among smokers and multiparous women (three pregnancies or more). Acetaminophen, scopolamine, and dimenhydrinate were the medications most commonly used. Conclusions: This study describes the pattern of drug use among pregnant women in a population-based cohort study, with a high prevalence of self-medication. Greater awareness of the risks of self-medication during pregnancy is required, focusing on groups more prone to this practice, as well as ensuring qualified multidisciplinary prenatal care.
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Affiliation(s)
- Bárbara Heather Lutz
- Faculty of Medicine, Department of Social Medicine & Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil
| | - Vanessa Iribarrem Avena Miranda
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil; (V.I.A.M.); (M.F.d.S.); (A.D.B.)
| | - Marysabel Pinto Telis Silveira
- Institute of Biology, Department of Physiology and Pharmacology & Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil;
| | - Tatiane da Silva Dal Pizzol
- Post-Graduate Program in Epidemiology, Federal University of Porto Alegre, Av. Ipiranga, 2752, Sala 203, Porto Alegre CEP 90610-000, RS, Brazil; (T.d.S.D.P.); (S.S.M.)
| | - Sotero Serrate Mengue
- Post-Graduate Program in Epidemiology, Federal University of Porto Alegre, Av. Ipiranga, 2752, Sala 203, Porto Alegre CEP 90610-000, RS, Brazil; (T.d.S.D.P.); (S.S.M.)
| | - Mariângela Freitas da Silveira
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil; (V.I.A.M.); (M.F.d.S.); (A.D.B.)
| | - Marlos Rodrigues Domingues
- Post Graduate Program in Physical Education & Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil;
| | - Andréa Dâmaso Bertoldi
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil; (V.I.A.M.); (M.F.d.S.); (A.D.B.)
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Justina VD, Gonçalves JS, David FL, Giachini FR, Lima VV. Evaluation of drug prescriptions for pregnant women in the Legal Amazon Region. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2018. [DOI: 10.1590/1806-93042018000400004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to evaluate the drug prescriptions for pregnant women in the Legal Amazon during prenatal care. Methods: this is a pharmacoepidemiological, descriptive, retrospective and cross-sectional study. Medical records included sociodemographic variables, prenatal care, most frequent pharmacological classes prescribed, risk classification of drugs and possible drug-drug interactions among pregnant women. Results: a total of 159 records from pregnant women, enrolled in the Unified Health System were used. Most pregnant women began prenatal consultations in the first trimester of pregnancy (53.3%) whereas most of the drugs were prescribed in the second gestational trimester (55.5%). The most used pharmacological classes, classified according to the National List of Essential Drugs were: antianemic preparations (52.9%), vitamins (12.5%) and analgesic (10.6%). According to the risk classification, the highest prevalence of prescribed drugs belongs to category A (46.8%), followed by category C (28.9%), category B (20.0%) and category D (4.3%). Eight possible drug-drug interactions were found, being considered with mild severity, and six classified with moderate risk. Conclusions: the results demonstrate a lack of information regarding prescription drugs for pregnant women and this may endanger maternal and fetal health. It is essential that medical records be an effective therapeutic tool, which should be read, analyzed and reviewed in order to ensure effective and safe medical treatment.
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Tovo-Rodrigues L, Schneider BC, Martins-Silva T, Del-Ponte B, Loret de Mola C, Schuler-Faccini L, Vianna FSL, Munhoz TN, Entiauspe L, Silveira MF, Santos IS, Matijasevich A, Barros AJD, Rohde LA, Bertoldi AD. Is intrauterine exposure to acetaminophen associated with emotional and hyperactivity problems during childhood? Findings from the 2004 Pelotas birth cohort. BMC Psychiatry 2018; 18:368. [PMID: 30458756 PMCID: PMC6245767 DOI: 10.1186/s12888-018-1942-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Longitudinal studies have consistently reported that prenatal exposure to acetaminophen can to lead to an increased risk of attention deficit-hyperactivity disorder during childhood. This study aimed to investigate the association between intrauterine exposure to acetaminophen and the presence of emotional and behavioral problems at the ages of 6 and 11 years in a low-middle income country. METHODS We performed a prospective longitudinal population-based study using data from the 2004 Pelotas birth cohort. From the 4231 initial cohort participants, 3722 and 3566 children were assessed at 6 and 11 years of age, respectively. The outcomes were assessed using the parent version of Strengths and Difficulties Questionnaire (SDQ). The cut-off points established for the Brazilian population were used to categorize the outcomes. Crude and adjusted odds ratio were obtained through logistic regression. RESULTS Acetaminophen was used by 27.5% (95% confidence interval [CI]: 26.1-28.9) of the mothers at least once during pregnancy. The prevalence of emotional problems at 6 and 11 years was 13.6 and 19.9%, respectively. For hyperactivity problems, prevalence was 13.9 and 16.1%, respectively. Intrauterine exposure to acetaminophen increased the odds of having emotional (odds ratio [OR] = 1.47; 95% CI: 1.07-2.02) and hyperactivity/inattention (OR = 1.42; 95% CI: 1.06-1.92) problems in 6-year-old boys. At the age of 11, a small decrease in the effect was observed for both outcomes after adjustment: OR = 1.31 (95% CI: 0.99-1.73) for emotional problems and OR = 1.25 (95% CI: 0.95-1.65) for hyperactivity/inattention in boys. No association for any phenotypes at both ages was observed for girls. CONCLUSION The effect of intrauterine exposure to acetaminophen in emotional and hyperactivity symptoms was dependent on sex in a Brazilian cohort. While it seemed to be important for boys, mainly at 6 years of age, for girls, no association was observed.
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Affiliation(s)
- Luciana Tovo-Rodrigues
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS, 96020-220, Brazil.
| | - Bruna Celestino Schneider
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Thais Martins-Silva
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Bianca Del-Ponte
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Christian Loret de Mola
- 0000 0001 2134 6519grid.411221.5School of Nursing and Public Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Fernanda Sales Luiz Vianna
- 0000 0001 2200 7498grid.8532.cPostgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande Do Sul, Porto Alegre, Brazil ,0000 0001 0125 3761grid.414449.8Genomic Medicine Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil ,0000 0001 0125 3761grid.414449.8Laboratory of Research in Bioethics and Ethics in Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Tiago N. Munhoz
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil ,0000 0001 2134 6519grid.411221.5Department of Psychology, School of Medicine, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Ludmila Entiauspe
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Mariângela Freitas Silveira
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Iná S. Santos
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Alicia Matijasevich
- 0000 0004 1937 0722grid.11899.38Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Aluísio J. D. Barros
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Luis Augusto Rohde
- 0000 0001 2200 7498grid.8532.cDepartment of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil ,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Andréa Dâmaso Bertoldi
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
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Costa DB, Coelho HLL, Santos DBD. [Use of medicines before and during pregnancy: prevalence and associated factors]. CAD SAUDE PUBLICA 2017; 33:e00126215. [PMID: 28300968 DOI: 10.1590/0102-311x00126215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 04/18/2016] [Indexed: 11/21/2022] Open
Abstract
This cross-sectional prospective nested cohort study aimed to assess the prevalence of use of medication before and during pregnancy and associated factors in women in a municipality in the countryside of Bahia State, Brazil. Data were collected with a structured questionnaire applied to pregnant women at their prenatal visits at health units. Prevalence rates for use of medication before and during pregnancy were 52.1% and 84.7%, respectively. The following were associated with use of medication before pregnancy: age ≥ 30 years, non-white skin color, first prenatal visit after the 1st trimester, and economic classes C/D/E. There was an increase in medication during pregnancy among women with ≥ 11 years of schooling, women with more than three prenatal visits, and those with some health problem. Pregnant women are exposed to medication before and during pregnancy, notwithstanding the lack of secure information to back the use of medicines during this phase; such use is associated with factors pertaining to prenatal follow-up, suggesting the need for more active participation by pharmacists in orientation and support for rational use of medicines.
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Affiliation(s)
| | | | - Djanilson Barbosa Dos Santos
- Universidade Federal do Ceará, Fortaleza, Brasil.,Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia, Santo Antônio de Jesus, Brasil
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Eze UI, Eferakeya AE, Oparah AC, Enato EF. Assessment of prescription profile of pregnant women visiting antenatal clinics. Pharm Pract (Granada) 2014; 5:135-9. [PMID: 25214930 PMCID: PMC4154748 DOI: 10.4321/s1886-36552007000300007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
UNLABELLED Managing medical complications in pregnancy is a challenge to clinicians. OBJECTIVES This study profiled some disease and prescription patterns for pregnant women attending antenatal clinics (ANCs) in Nigeria. A risk classification of the medicines was also determined. METHODS Medical case files of 1,200 pregnant women attending antenatal clinics of 3 health facilities in Benin City, Nigeria were investigated. Disease pattern was determined from their diagnoses. The prescription pattern was assessed using WHO indicators, and the United States Food and Drug Administration classification of medicines according to risk to the foetus. RESULTS A total of 1,897 prescriptions of the 1,200 pregnant women attendees during the period under review were evaluated. Results indicated that malaria 554 (38%) was the most prevalent disease, followed by upper respiratory tract infections (URTIs, 13%) and gastrointestinal disturbances (GIT, 12%). The average number of drugs prescribed per encounter was found to be 3.0, and 2,434 (43%) of medicines were prescribed by generic name. Minerals/ Vitamins 2,396 (42%) were the most frequently prescribed medicines, and antibiotics occurred in 502 (8.8%) of the total medicines. Of all medicines prescribed, 984 (17%) were included in the foetal risk category C and 286 (5%) in category D. CONCLUSION The study concluded that malaria fever occurred most frequently followed by URTIs and GIT disturbances among the pregnant women. Minerals, vitamins and to a less extent antimalarials topped the list of the prescribed medicines. The average number of medicines per encounter was much higher than WHO standards. The occurrence of contraindicated medicines was low.
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Affiliation(s)
- Uchenna I Eze
- Department of Clinical Pharmacy/Biopharmacy, Faculty of Pharmacy, Olabisi Onabanjo University Shagamu Campus, Shagamu ( Nigeria )
| | - Adego E Eferakeya
- Department of Pharmacology &Toxicology, Faculty of Pharmacy, University of Benin , Benin City ( Nigeria )
| | - Azuka C Oparah
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, University of Benin , Benin City ( Nigeria )
| | - Ehijie F Enato
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, University of Benin , Benin City ( Nigeria )
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Use of medicines with unknown fetal risk among parturient women from the 2004 Pelotas Birth Cohort (Brazil). J Pregnancy 2012; 2012:257597. [PMID: 23346403 PMCID: PMC3549362 DOI: 10.1155/2012/257597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 11/25/2012] [Accepted: 11/26/2012] [Indexed: 11/18/2022] Open
Abstract
Background. To estimate the exposure to medicines with unknown fetal risk during pregnancy and to analyze the maternal characteristics associated with it. Methods. A questionnaire was administered to 4,189 mothers of children belonging to the 2004 Pelotas (Brazil) birth cohort study about use of any medicine during gestation. We evaluated the associations between use of medicines with unknown fetal risk and the independent variables through logistic regression models. Unknown fetal risk was defined as medicines in which studies in animals have revealed adverse effects on the fetus, and no controlled studies in women, or studies in women and animals, are available. Results. Out of the 4,189 women, 52.5% used at least one medicine from unknown fetal risk. Use of these medicines was associated with white skin color, high schooling, high income, six or more antenatal care consultations, hospital admission during pregnancy, and morbidity during gestation. Conclusion. The use of unknown fetal risk medicines is high, suggesting that their use must be addressed with caution with the aim of restricting their use to cases in which the benefits are greater than the potential risks.
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Brum LFDS, Pereira P, Felicetti LL, da Silveira RD. [Prescribed and unprescribed drug use among pregnant patients attended by the Unified Health System in Santa Rosa (State of Rio Grande do Sul, Brazil)]. CIENCIA & SAUDE COLETIVA 2011; 16:2435-42. [PMID: 21655716 DOI: 10.1590/s1413-81232011000500012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Indexed: 11/21/2022] Open
Abstract
In order to ascertain the use of prescribed and unprescribed drugs among pregnant patients of the Unified Health System (SUS), a descriptive study comprised of a sample of pregnant women was carried out in the city of Santa Rosa, State of Rio Grande do Sul, Brazil. Data were collected by means of structured interviews and consultation of patient records of pregnant women in the prenatal period. The prevalence of drug use was 90%, corresponding to an average of 4.1 drugs per pregnant woman, of which 83.6% were prescribed and 16.4% were self-medicated. Of this total, 17.5% of the drugs were included in fetal risk category C. The use of drugs during pregnancy is frequent and the majority of the pregnant women used one or more prescribed and unprescribed drugs during pregnancy. These data suggest the need for preventive measures to promote rational drug use during pregnancy.
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Affiliation(s)
- Lucimar Filot da Silva Brum
- Curso de Farmácia, Universidade Luterana do Brasil. Av. Farroupilha 8001, prédio 01, sala 29, São José. 92420-280 Canoas RS.
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Dal Pizzol TDS, Giugliani ERJ, Mengue SS. [Association between iron supplementation during pregnancy and prematurity, low birth weight, and very low birth weight]. CAD SAUDE PUBLICA 2009; 25:160-8. [PMID: 19180298 DOI: 10.1590/s0102-311x2009000100017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 06/10/2008] [Indexed: 05/25/2023] Open
Abstract
The objective was to evaluate the association between prophylactic iron supplementation and prematurity and low birth weight. Pregnant women 20 years and older with 21 to 28 weeks of gestational age were enrolled consecutively in prenatal services in the Unified National Health System in six Brazilian State capitals between 1991 and 1995. Socio-demographic data and information on iron supplementation up until the 28th gestational week were obtained by means of an interview. Outcomes and other variables were collected from medical records. Anemia was present in 31.3% of the 3,865 women. Among anemic women (hemoglobin < 11.0g/dL), 29.8% were taking iron supplements, as compared to 16.7% among non-anemic women (hemoglobin > or = 11.0g/dL). After adjusting for potential confounders, iron was not associated with prematurity (OR = 0.88; 95%CI: 0.73-1.07), low birth weight (OR = 0.99; 95%CI: 0.75-1.31), or very low birth weight (OR = 0.58; 95%CI: 0.29-1.13). The results suggest that iron supplementation up to the 28th gestational week does not reduce the risk of prematurity, low birth weight, or very low birth weight.
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Melo SCCSD, Pelloso SM, Carvalho MDDB, Oliveira NLBD. Uso de medicamentos por gestantes usuárias do Sistema Único de Saúde. ACTA PAUL ENFERM 2009. [DOI: 10.1590/s0103-21002009000100011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Identificar o uso de medicamentos por gestantes usuárias do Sistema Único de Saúde do município de Bandeirantes - Paraná. MÉTODOS: Estudo analítico transversal. População: 245 gestantes e amostra de 205. O instrumento para coleta de dados foi um questionário estruturado. Estudo realizado de julho de 2006 a novembro de 2007. RESULTADOS: 83,4% das gestantes entrevistadas declararam utilizar pelo menos um medicamento, destas 8,2% o fizeram sem prescrição médica e 80,5% receberam alerta sobre perigos de certos medicamentos. Os dados evidenciaram uma relação estatisticamente significante entre o 3º trimestre e o maior uso de medicamentos. Sulfato ferroso (45,0%) e paracetamol (43,4%) foram os mais utilizados, porém medicamentos considerados de risco para o feto também foram empregados. CONCLUSÃO: As gestantes estão sendo expostas a uma variedade de medicamentos, o que exige atenção criteriosa para evitar possíveis danos ao feto.
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Lunet N, Rodrigues T, Correia S, Barros H. Adequacy of prenatal care as a major determinant of folic acid, iron, and vitamin intake during pregnancy. CAD SAUDE PUBLICA 2008; 24:1151-7. [PMID: 18461244 DOI: 10.1590/s0102-311x2008000500022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 10/08/2007] [Indexed: 11/22/2022] Open
Abstract
This study aimed to quantify the association between adequacy of prenatal care and prevalence of folic acid, iron, and multivitamin intake during pregnancy. Data were obtained on socio-demographics, prenatal care, pregnancy complications, and use of vitamin/mineral supplements for 836 women, using a postpartum interview. Associations with the use of vitamin/mineral supplements were quantified with risk ratios (RR), computed by generalized binomial regression. A high proportion of women reported the use of folic acid (81.9%), iron (55.4%), and multivitamins (76.2%) as supplements during pregnancy. Use of supplements was independently associated with adequacy of prenatal care (adequate vs. inadequate: folic acid, RR = 2.28; 95%CI: 1.58-3.29; iron, RR = 1.99; 95%CI: 1.57-2.52, multivitamins, RR = 1.97; 95%CI: 1.54-2.51). Higher schooling was also associated with increased use of folic acid (RR = 1.42; 95%CI: 1.18-1.70), but not multivitamins (RR = 0.87; 95%CI: 0.77-0.98). Use of folic acid was less prevalent in single women (RR = 0.67; 95%CI: 0.48-0.95) and during unplanned pregnancies (RR = 0.81; 95%CI: 0.71-0.92). Adequacy of prenatal care is a major determinant of vitamin/mineral intake during pregnancy.
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Affiliation(s)
- Nuno Lunet
- Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, Porto, Portugal.
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da Silva Dal Pizzol T, Schüler-Faccini L, Mengue SS, Fischer MI. Dipyrone use during pregnancy and adverse perinatal events. Arch Gynecol Obstet 2008; 279:293-7. [DOI: 10.1007/s00404-008-0707-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 06/02/2008] [Indexed: 10/21/2022]
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Geib LTC, Vargas Filho EF, Geib D, Mesquita DI, Nunes ML. [Prevalence and determinants of medication during pregnancy by risk class among mothers of liveborn infants]. CAD SAUDE PUBLICA 2008; 23:2351-62. [PMID: 17891296 DOI: 10.1590/s0102-311x2007001000010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Accepted: 04/19/2007] [Indexed: 11/22/2022] Open
Abstract
In order to identify the maternal determinants of the consumption of medication during pregnancy according to risk class, we conducted a population cohort baseline cross-sectional study with 2,262 mothers of liveborn infants in Passo Fundo, Rio Grande do Sul, Brazil. Data were collected from the Information System on Live Births and through home interviews (an instrument adapted from the Maternity Advice Survey). The drugs were classified according to criteria. We conducted bivariate analyses and logistic regression according to the hierarchical model of determination. 80% of the mothers consumed at least one medicine during the pregnancy, distributed in risk classes as follows: A (53.4%), B (18.1%), C (24.46%), D (1.47%), X (0.06%), and V (various) (2.1%). Incomplete prenatal care and maternal age < 20 years determined the consumption of medication in class A and pregnancy complications in classes B, C, and D. In class C, cesarean section and previous abortion also determined consumption, which in class V was independent of the variables analyzed. Maternal factors, especially health complications, determine the consumption of medicines during pregnancy, suggesting that the prescribing physician should orient the safe and proper use of such medication.
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Leite SN, Vieira M, Veber AP. Estudos de utilização de medicamentos: uma síntese de artigos publicados no Brasil e América Latina. CIENCIA & SAUDE COLETIVA 2008; 13 Suppl:793-802. [DOI: 10.1590/s1413-81232008000700029] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O medicamento tem se convertido em elemento importante na recuperação e garantia da qualidade de vida; no entanto, há riscos evitáveis associados a seu uso. Neste contexto, o objetivo deste trabalho foi analisar as publicações de estudos de utilização de medicamentos quanto aos tipos de resultados obtidos e suas contribuições para as intervenções terapêuticas. Foram analisados 27 artigos sobre estudos de utilização de medicamentos selecionados nas bases de dados Scielo e Lilacs em relação a objetivos, tipo de estudo, população e amostra selecionada, métodos de estudo e resultados mais relevantes. Os resultados dos artigos analisados foram discutidos a partir das categorias analíticas, criadas através da seleção dos temas emergentes da análise, prevalência do consumo de medicamentos, fatores relacionados ao uso de medicamentos, automedicação, organização dos serviços de saúde, percepção do medicamento e adesão à terapia. De forma geral, as sugestões dos autores restringiram-se à necessidade de prestar informação ao paciente. Conclui-se que as informações construídas pelos estudos de utilização de medicamentos podem ser o caminho inicial para a mudança tão almejada nas práticas profissionais.
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Maeda ST, Secoli SR. Use and cost of medication in low risk pregnant women. Rev Lat Am Enfermagem 2008; 16:266-71. [DOI: 10.1590/s0104-11692008000200015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Accepted: 12/12/2007] [Indexed: 11/22/2022] Open
Abstract
The objective of the present study is to assess the use of medication by pregnant women; classify them regarding therapy group and its risk category; and identify the cost of these drugs. The sample is formed by 47 pregnant women, in the 20 to 29 year-old age group, from July 2001 to June 2003, in the city of São Paulo. A specific instrument was used for data collection in family charts and others from the Sistema de Informação da Atenção Básica (Primary Care System Information). Average of medications used by pregnant woman was 3.63. Iron sulfate was the most commonly used, followed by antibiotics (78.7%). Regarding risk category, 34.1% of medications belonged to category B and 16.5% to category C. In the calculation of total costs of care, expenses with medication accounted for 11.13%. We have seen the need for assessing further the criteria for use, especially of medications of category C. The higher costs were related to antimicrobials for the treatment of infections.
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Rondó PHC, Fukushima CM, Moraes F. Vitamin–mineral supplement use by low-income Brazilian pregnant adolescents and non-adolescents and the predictors for non-use. Eur J Clin Nutr 2006; 60:1108-14. [PMID: 16538237 DOI: 10.1038/sj.ejcn.1602425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To determine (1) the intake of vitamin-mineral supplements by 855 low-income Brazilian pregnant adolescents and non-adolescents in three interviews (gestational ages < or =16, 20-26 and 30-36 weeks), (2) the relationship between vitamin-mineral supplementation and toxic exposure, and nutritional, psychological, socio-economic, demographic and obstetric characteristics of the women. DESIGN Longitudinal cohort study. SETTING Jundiaí city, São Paulo, Brazil. SUBJECTS A total of 855 pregnant adolescents and non-adolescents who attended antenatal care from September 1997 to August 2000. METHODS A general questionnaire was utilized three times in pregnancy (gestational ages < or =16, 20-26 and 30-36 weeks) to investigate the vitamin-mineral supplements ingested by the women, their smoking habit and alcohol intake, anthropometric measurements (pre-pregnancy and actual weight, height, mid-upper arm circumference) and psychological (anxiety, stress and distress), socio-economic (per capita income), demographic (education, age, marital status) and obstetric (gravidity) characteristics. The associations between vitamin-mineral supplementation and maternal characteristics were assessed in 12 multiple logistic regression models, stratifying the women by age and per capita income. RESULTS Iron and vitamin C were the most ingested supplements by adolescents and non-adolescents, in the three interviews. Logistic regression analysis revealed that the maternal predictors for non-use of vitamin-mineral supplementation were acute anxiety and alcohol intake for adolescents, and low education, single without partner, distress (anxiety, depression, etc.) and stress for non-adolescents. CONCLUSIONS These are important data to identify groups of low-income pregnant women in need of supplementation guidance and nutrition education. Stress/distress was a predictor for non-use of vitamin-mineral supplements for both adolescents and non-adolescents pregnant women.
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Affiliation(s)
- P H C Rondó
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
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Mengue SS, Schenkel EP, Schmidt MI, Duncan BB. Fatores associados ao uso de medicamentos durante a gestação em seis cidades brasileiras. CAD SAUDE PUBLICA 2004; 20:1602-8. [PMID: 15608862 DOI: 10.1590/s0102-311x2004000600018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste estudo foi comparar o uso de medicamentos durante a gravidez, segundo variáveis sócio-demográficas, em gestantes que fizeram o pré-natal em serviços do SUS em seis grandes cidades brasileiras. Utilizando-se um questionário estruturado, foram entrevistadas 5.564 gestantes que se apresentaram para consulta em serviço de pré-natal do SUS, participantes do Estudo Brasileiro de Diabetes Gestacional, entre 1991 e 1995. O uso de qualquer medicamento mostrou uma associação positiva com o aumento da escolaridade, da idade e com o fato de ter companheiro, e uma associação negativa com maior número de filhos. O uso de medicamentos multivitamínicos e medicamentos que atuam sobre o aparelho digestivo mostrou aumento da associação com maior escolaridade e idade e uma associação negativa com o aumento do número de filhos. O uso de medicamentos antianêmicos mostrou uma associação negativa com o aumento da escolaridade e com o aumento da idade. O uso de multivitamínicos e medicamentos que atuam sobre o aparelho digestivo mostrou uma associação com variáveis que caracterizam gestantes de melhor nível sócio-econômico, sugerindo que o uso de medicamentos é uma expressão de cuidado com a gestação.
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Affiliation(s)
- Sotero Serrate Mengue
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Carmo TAD, Nitrini SMOO. [Drug prescription for pregnant women: a pharmacoepidemiological study]. CAD SAUDE PUBLICA 2004; 20:1004-13. [PMID: 15300293 DOI: 10.1590/s0102-311x2004000400015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Prescription drug use by pregnant women should be viewed as a public health issue, since there are numerous gaps in knowledge on the consequences for both the mother and the fetus. Pharmacoepidemiological studies can help minimize the inherent risks in drug treatment by establishing a profile of drug consumption during pregnancy, providing an evaluation of this service, and identifying intervention measures. The purpose of this study was to establish a prescription profile for pregnant women treated under the National Health System (SUS) in Piracicaba, São Paulo State, Brazil, using prescription indicators recommended by the World Health Organization and the U.S. Food and Drug Administration classification of medicines according to risk to the fetus. According to the current study, during prenatal consultations 44.7% of the women received drug prescriptions, and the most widely prescribed group of drugs were those acting on the hematopoietic system (34.9%). Of this total, 26.0% of the drugs were included in fetal risk category C, 1.5% in category D, and 1.5% in category E. These data point to the medicalization of pregnancy and the need for intervention measures aimed at rational prescription drug use during the prenatal period.
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Affiliation(s)
- Thais Adriana do Carmo
- Faculdade de Ciências da Saúde, Universidade Metodista de Piracicaba, Piracicaba, Brazil.
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Tierling VL, Paulino MA, Fernandes LC, Schenkel EP, Mengue SS. Nível de conhecimento sobre a composição de analgésicos com ácido acetilsalicílico. Rev Saude Publica 2004; 38:223-7. [PMID: 15122378 DOI: 10.1590/s0034-89102004000200011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar o conhecimento sobre a designação genérica, uso e composição de medicamentos analgésicos contendo ácido acetilsalicílico. MÉTODOS: Foram realizadas 124 entrevistas entre dezembro de 1999 e janeiro de 2000, em dois bairros da cidade de Porto Alegre, RS. As entrevistas foram respondidas pela pessoa que atendeu o entrevistador em cada um dos domicílios sorteados. Os instrumentos de coleta de dados foram uma cartela com cinco especialidades farmacêuticas de analgésicos contendo ácido acetilsalicílico e uma entrevista com duas perguntas abertas sobre diferenças e semelhanças entre os produtos. RESULTADOS: A partir do nível de informação demonstrado pelos entrevistados, foram caracterizados três grandes grupos de conhecimento. O grupo das pessoas que demonstraram domínio sobre o assunto foi de 14 indivíduos (11%); os que demonstraram domínio limitado foi de 61 pessoas (49%); e os que não demonstraram domínio sobre o assunto formaram um grupo de 49 pessoas (40%). CONCLUSÕES: Considerando o conjunto de resultados, verificou-se que a maioria das pessoas (cerca de 90% na amostra avaliada) simplesmente desconhece qual a substância ativa presente em uma especialidade farmacêutica de seu uso freqüente.
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Affiliation(s)
- Vera L Tierling
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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