Main results
This study used primary care electronic medical records to describe the prevalence of polypharmacy and common medications prescribed during pregnancy in the UK. One-quarter (24.6%) of all women’s pregnancies and one-half (49.8%) of women’s pregnancies with multiple comorbidities had two or more pregnancies during the first trimester of pregnancy, when exposure to teratogens is of greatest concern. was prescribed medicine for Across pregnancies, the prevalence of 2 or more drugs prescribed was even higher (58.7% and 80.3%, respectively). Over the last 20 years, from 2000 to 2019, we observed a trend towards a significantly increasing prevalence of polypharmacy in both all pregnancies and pregnancies of women with multiple comorbidities.
Medications commonly prescribed during pregnancy were (1) medications typically used to manage pregnancy-related symptoms or illnesses, such as oral iron, analgesics, laxatives, antiemetics, and antacids; (2) Bacterial or fungal infections, such as broad-spectrum penicillins, and preparations for vaginal and vulvar candidiasis; (3) General mental health conditions, such as SSRIs; (4) Selective beta 2 agonists and topical corticosteroids, etc. asthmatic and atopic conditions.
The 10 most common drug combinations prescribed to manage two different long-term health conditions in pregnant women with multiple diseases in the first trimester of pregnancy all included either SSRIs or selective beta-2 agonists. A combination was included.
Pregnant women in younger or older age groups (<25 years and >35 years) with high pre-pregnancy BMI, high levels of socioeconomic deprivation, smokers or former smokers, and high levels of multimorbidity , was associated with higher odds of prescribing 2. and 5 or more drugs
Comparison with existing literature
The prevalence of polypharmacy in pregnancy (defined as two or more medications prescribed) observed in this study (58.7%) was comparable to the findings of the Dutch study (62.4%) . [32]However, this was higher than the estimate reported in the Danish population-based study (42.7%). [33]Ireland (29.4%) [12]China (9.2%) [9] and the Netherlands (4.9%) [34]Similarly, the prevalence of other numerical definitions of polypharmacy estimated in this study is higher than the estimates reported in the Danish study (41.0% vs 2.7%, definition 3+ drugs). . [11]North American study (27.8% vs 4.9%, definition 4+ medication) [3] and Finnish study (2.2% vs 0.2%, definition 10+ medication) [14].
Several reasons may be attributed to the high prevalence of polypharmacy during pregnancy reported in this study. Various methods have been used in the literature to obtain prescription data, including pharmacy records. [9, 33, 34]the National Register [11, 14, 15] and self-reported drug use [6, 12, 35,36,37]This study captured prescribed medications based on primary care records, whether dispensed or taken, whereas other studies where pharmacy records or surveys were used found that medication consumption was captured more accurately.Some studies collected data from periods prior to this study [11, 14]This corresponds to the low prevalence of polypharmacy observed early in the study, followed by an increasing trend. Although our study included vitamins and minerals commonly taken during pregnancy (except folic acid), these prescriptions documented in primary care are not for therapeutic use (oral iron for iron deficiency). may reflect the therapeutic dose of This is in contrast to supplements that are commonly purchased over-the-counter.These prescriptions were excluded from many other studies [3, 11, 38]The wide range of prevalence estimates reported in the literature is due to differences in international practices and healthcare systems, such as prescription payments that discourage patients from requesting prescriptions, and the types of drugs available over the counter. may also be caused.
The prevalence of common drugs and their prescriptions observed during pregnancy in our study is broadly comparable to other previous studies.This includes antibiotics and treatment for asthma, allergies and anemia [13, 32, 35]Some differences in findings from previously published literature [6]Such as the low prevalence of products used against nausea and dizziness, may reflect the purchase of these products over the counter as opposed to prescription procurement of these products.
Some of the risk factors for polypharmacy during pregnancy observed in our study have been previously described in other studies by Zhang et al. [9] and Cleary et al. [12]This includes maternal age and smoking as risk factors for an increased number of medications used during pregnancy, and the prescribing of U.S. Food and Drug Administration (FDA) Category D/X medications (positive for human fetal risk). there is strong evidence). However, neither study suggested younger maternal age as a risk factor.
strengths and limitations
The study has important strengths, including a large cohort size of 1.5 million eligible pregnancies and a complete follow-up of 812,354 first trimesters from the UK generalizable primary care database. To our knowledge, this is the first study to report on the prevalence and prevalence of polypharmacy in both individual and paired pregnancies. Women with multiple comorbidities.
However, certain definitions of polypharmacy (prescribing multiple drugs ranging from 2 to 11 or more within a pre-defined period of gestation either in the first trimester or throughout the gestational period) had limitations. It was not possible to determine the adequacy of prescribed medications because the drug indications were not available in the dataset and the cohort size prohibits case-by-case testing. It is also not possible to determine whether the drugs were prescribed at the same time. Furthermore, our definition of polypharmacy is based only on primary care prescriptions, and we do not know if the drugs were actually dispensed and taken. [39] Nor did we capture over-the-counter and second-line medications that may have over- or underestimated our findings, respectively.
Of the pregnancies recorded on the CPRD GOLD Pregnancy Register, 52.4% were excluded based on standard practice exclusion criteria due to lack of patient or clinic eligibility at the onset of pregnancy. Additionally, 22.1% of pregnancies were excluded due to incomplete first trimester follow-up. To examine potential selection bias, we performed a sensitivity analysis including all eligible pregnancies with or without full follow-up. Similar findings were observed there.
Clinical and research implications
Polypharmacy is known to be associated with multimorbidity in the general population [40, 41]However, much research on polypharmacy has focused on older adults. [42, 43], less attention is paid to pregnant women and women of childbearing age. As observed in our analysis, pregnancy is often associated with prescribing medications to manage common pregnancy-related symptoms and ailments such as pain, nausea, and dyspepsia. This need for medication further increases the medication burden for women with multimorbidity who may already be taking medication regularly for potential long-term health conditions. confirmed by our research results. The prevalence of polypharmacy is significantly higher in pregnancies of women with multiple comorbidities compared to all pregnancies in general, and the relative difference in its prevalence may affect the drugs considered in the definition of polypharmacy. increased with the number of (Fig. 1). .
Among women with multiple comorbidities, SSRIs were the most commonly prescribed drug during early pregnancy (15.2%) and the seventh most commonly prescribed drug throughout pregnancy (17.4%). SSRIs were also frequently observed among common drug combinations.This reflects the high prevalence of mental health conditions in pregnant women with multiple comorbidities observed in previous studies. [1]Given the uncertainties in the safety of antidepressant treatment during pregnancy [44]and competing risks of untreated mental health conditions [45]this area warrants further research.
Our findings evaluating risk factors for polypharmacy indicate that women aged 25 to 34 years were at the lowest risk of polypharmacy during pregnancy and mothers distant from the central gestational age of 25 to 34 years. It suggested that risk increases with both increasing and decreasing age. Women who became pregnant in their teens were more than twice as likely to be prescribed multiple medications as women who were pregnant between the ages of 30 and 34. This may be due to women under the age of 20 being entitled to free prescriptions. [46]Additionally, pregnant teenage women are more likely to take supplements to prevent iron deficiency anemia and treat sexually transmitted infections. [47].
There is growing recognition that long-term medications should be continued during pregnancy if safe and the benefits outweigh the risks. In particular, the assessment of teratogenic risk is primarily focused on the use of individual medicinal products. Little is known about the combined effects of drugs taken simultaneously during pregnancy. To empower women and clinicians, more research is needed on the effects of concomitant medications taken during pregnancy on women and their fetuses.
