Prevalence of polypharmacy in pregnancy: a systematic review

Abstract

ObjectivesThe use of medications among pregnant women has been rising over the past few decades but the reporting of polypharmacy has been sporadic. The objective of this review is to identify literature reporting the prevalence of polypharmacy among pregnant women, the prevalence of multimorbidity in women taking multiple medications in pregnancy and associated effects on maternal and offspring outcomes.DesignMEDLINE and Embase were searched from their inception to 14 September 2021 for interventional trials, observational studies and systematic reviews reporting on the prevalence of polypharmacy or the use of multiple medications in pregnancy were included.Data on prevalence of polypharmacy, prevalence of multimorbidity, combinations of medications and pregnancy and offspring outcomes were extracted. A descriptive analysis was performed.ResultsFourteen studies met the review criteria. The prevalence of women being prescribed two or more medications during pregnancy ranged from 4.9% (4.3%–5.5%) to 62.4% (61.3%–63.5%), with a median of 22.5%. For the first trimester, prevalence ranged from 4.9% (4.7%–5.14%) to 33.7% (32.2%–35.1%). No study reported on the prevalence of multimorbidity, or associated pregnancy outcomes in women exposed to polypharmacy.ConclusionThere is a significant burden of polypharmacy among pregnant women. There is a need for evidence on the combinations of medications prescribed in pregnancy, how this specifically affects women with multiple long-term conditions and the associated benefits and harms.Tweetable abstractOur systematic review shows significant burden of polypharmacy in pregnancy but outcomes for women and offspring are unknown.PROSPERO registration numberCRD42021223966.

The use, perceptions and knowledge of safety of over-the-counter medications during pregnancy in a Canadian population

“… 14 It is possible that the combined effect of ingredients also might potentiate a harmful effect. 2 A systematic review reported a prevalence of polypharmacy including OTC medications ranging from 4.9% to 38.3%, 26 and an early study of women in Connecticut identified that women who use prescription medications were more likely to use OTC. 27 Significant evidence gaps exist in understanding the teratogenic risk of the vast majority of medications used in early pregnancy, 21 particularly in combination.…”