How to Improve Information on Medication Exposure during Pregnancy

Abstract

In developed countries, the majority of women use over the counter (OTC) or prescribed medication during pregnancy. [1][2][3][4] Although a large proportion of these medications are iron, vitamins, folic acid and other multivitamin supplements, many women use prescribed drugs for chronic diseases like thyroid disorders, asthma, psychiatric illness, hypertension, diabetes and chronic inflammatory diseases such as ulcerative colitis, Crohn's disease and rheumatoid arthritis. The risk-benefit profile of medications used during pregnancy is assessed mostly on postauthori sation studies. 5Women with chronic disease who previously were advised against having children today become pregnant to a larger extent. Hence, specialists and obstetricians now care for a new class of pregnant women, and the issue of disease, disease severity and the possible adverse medication effects is complicated. There are risks associated with medication use during pregnancy, and the most common reason for discontinuing medication is related to risk of birth defects.6 Women tend to overestimate the risk of medication use and also other exposures during pregnancy. 6 Many choose to discontinue or lower the dose of their medication, sometimes without notifying their treating physician making this information hard to ascertain. There are many sources of information for medica tion use during pregnancy including medical birth registers, prescribed drug registers, administrative databases like claims data, and questionnaire-based methods. Lately, electronic medical records and have also been included in this foray. Each method has its strengths, but also limitations with risk of ascertain ment bias and misclassification. 5Prospectively collected data are always preferable to reduce bias due to recall. Some studies have reported data on the agreement between birth register or prescribed drug register information and maternal report drug use during pregnancy. 2,4,5,7,8 However, agreement between maternal report and medical records has been less studied. 9In this issue of Paediatric and Perinatal Epidemiology, Palmsten and colleagues 10 report on the comparability of information on medication exposures for rheuma toid arthritis and asthma during pregnancy collected in prospective cohorts from maternal report and medical records. The study included pregnant women with rheumatoid arthritis (n = 216) or asthma (n = 172) from the USA and Canada enrolled in the MotherToBaby or Autoimmune Diseases in Pregnancy studies. Women reported dates and types of medications used through semistructured telephone interviews that were compared to the obstetrical records and/or medical records of special ists in rheumatology or allergy. Agreement was estimated using Cohen's kappa coefficients with 95% confidence intervals (CI) for concordance between maternal report and medical record. The study found that prevalence estimates of medications differed by information source and were highest when both maternal report and medical records were used. Agreement varied accordin...

Adherence to prescription medication during pregnancy: Do pregnant women use pharmacological treatment as prescribed?

“…Mobile applications to daily record medication intake may improve the feasibility of intensive long-term data collection. 53 Social desirability might have increased reporting of medication use when not actually taken, but this was considered unlikely as participants were unaware of the aim of this study. Also, we were unable to distinguish between intentional and unintentional avoidance of medication use.…”

“…Adherence is expected to be lower in the first trimester of pregnancy because of fear for teratogenicity, but it was considered not feasible to administer diaries immediately after inclusion in the PRIDE Study until delivery due to participant burden. Mobile applications to daily record medication intake may improve the feasibility of intensive long‐term data collection 53 . Social desirability might have increased reporting of medication use when not actually taken, but this was considered unlikely as participants were unaware of the aim of this study.…”