Risks versus benefits of medication use during pregnancy: what do women perceive?

Abstract

BackgroundUnderstanding perception of risks and benefits is essential for informed patient choices regarding medical care. The primary aim of this study was to evaluate the perception of risks and benefits of 9 drug classes during pregnancy and associations with women’s characteristics.MethodsQuestionnaires were distributed to pregnant women who attended a Dutch Obstetric Care facility (first- and second-line care). Mean perceived risk and benefit scores were computed for 9 different drug classes (paracetamol, antacids, antibiotics, antifungal medication, drugs against nausea and vomiting, histamine-2 receptor antagonists/proton pump inhibitors, antidepressants, nonsteroidal anti-inflammatory drugs, and sedatives/anxiolytics). For each participant, we computed weighted risk and benefit sum scores with principal component analysis. In addition, major concerns regarding medication use were evaluated.ResultsThe questionnaire was completed by 136 women (response rate 77%). Pregnant women were most concerned about having a child with a birth defect (35%), a miscarriage (35%), or their child developing an allergic disease (23%), respectively, as a result of drug use. The majority of studied drug classes were perceived relatively low in risk and high in benefit. Higher risk scores were reported if women were in their first trimesters of pregnancy (p=0.007). Lower benefit scores were reported if women were single (p=0.014), smoking (p=0.028), nulliparous (p=0.006), or did not have a family history of birth defects (p=0.005).ConclusionPregnant women’s concerns regarding potential drug adverse effects were not only focused on congenital birth defects but also included a wider range of adverse outcomes. This study showed that most of the studied drug classes were perceived relatively low in risk and high in benefit.

Women’s Beliefs About Medicines and Adherence to Pharmacotherapy in Pregnancy: Opportunities for Community Pharmacists

“…Most studies found that women were more reluctant to use medicines during pregnancy and tended to overestimate the teratogenic risk of medicines. Willingness to initiate or continue medication use, however, depended on their severity of illness and whether they were pregnant or had recently delivered at the time they reported on beliefs about medicines in pregnancy [26][27][28][29][30][31][32]. The most common fear in using medicines during pregnancy appeared to be the risk of harming the unborn child [6,27,29,30].…”

“…Willingness to initiate or continue medication use, however, depended on their severity of illness and whether they were pregnant or had recently delivered at the time they reported on beliefs about medicines in pregnancy [26][27][28][29][30][31][32]. The most common fear in using medicines during pregnancy appeared to be the risk of harming the unborn child [6,27,29,30]. The framing of this information appeared important for the overall assessment of risk [33], while the first person to give participants this information was more likely to influence their final decision [34].…”

“…The majority of studies highlighted that the perceived risk of taking medicines during pregnancy does not apply to all categories of medicines equally. In these studies, women frequently reported antidepressants and anxiolytics as those with the highest risk, and antibiotics and paracetamol with the lowest risk or greatest benefit [27,35,37,38]. 6 Self-generated questions on attitudes towards medicines Women who were more likely to use medicines thought that it was better for the fetus to use medicines and get better than leave the illness untreated.…”

“…Furthermore, risk perception seemed to vary with the type of medicine, level of health literacy, education level and occupation [27,28,[35][36][37][38]. Overall, the most common fear in using medicines during pregnancy appeared to be the risk of harming the unborn child [6,27,29].…”

SafeMotherMedicine: Aiming to Increase Women’s Empowerment in Use of Medications During Pregnancy and Breastfeeding

“…A study that investigated pregnant women's perception of risk and benefits of medications, found that the risks and benefit scores were significantly inversely correlated (Mulder et al 2017). This implies that clear communication of the benefits of the medications may reduce the women's risk perception, and increase their empowerment with regard to medications.…”