Prevalence of polypharmacy in pregnancy

Conference:

SAPC ASM 2021 - virtual

Talk Code:

P1.29.2

Presenter:

Astha Anand

Twitter:

@AsthaAnand9

Co-authors:

Astha Anand, Siang Lee, Anuradhaa Subramanian, Zhaonan Wang, Krishnarajah Niranthakumar, Peter Brocklehurst, Catherine Nelson-Piercy, Amaya Azcoaga-Lorenzo, on behalf of MuM-PreDiCT consortium

Author institutions:

Institute of Applied Health Research University of Birmingham, University of St. Andrews, Queen’s University Belfast, University of Aberdeen, University of Keele, University of Manchester, University of Swansea, Aberdeen Maternity Hospital, NHS Grampian, Birmingham Women’s and Children’s NHS Foundation Trust, Guy’s and St Thomas’ NHS Foundation Trust, Royal Jubilee Maternity Hospital Belfast, Belf

Problem

The use of medications amongst pregnant women has been rising over the past few decades. Whilst several studies have assessed overall medication use amongst pregnant women, the reporting of polypharmacy has been sporadic. Medications can be used to manage pregnancy symptoms (such as nausea and vomiting), pre-existing maternal morbidities or pregnancy related morbidities. Primary care physicians are involved in prescribing and monitoring of medications in pregnant women. However, little is known about the effect of combining medications – whether these combinations worsen known side effects, result in novel adverse events or have a synergistic or beneficial effect.

Approach

A systematic review was performed in order to identify the published literature reporting on the prevalence of polypharmacy or the use of multiple medications amongst pregnant women and the common combinations of medications used. Protocol for this systematic review has been published on Prospero (Protocol ID CRD42021223966). Randomised trials, observational trials (cohort studies and case control studies) and systematic reviews reporting the prevalence of polypharmacy in pregnant women were included. MEDLINE and Embase were searched for all relevant articles till 3rd January 2021. The study authors’ definition of polypharmacy was used; where this was not available, we defined polypharmacy to mean use of two or more medications. Two independent reviewers extracted the data.

Findings

Of the 2136 records identified, fourteen met the review criteria. Polypharmacy prevalence is very heterogenous, due to the varied definitions of polypharmacy, whether over-the-counter medications were included and whether prenatal vitamins and minerals were included. The definition of polypharmacy ranged from the use of 2 or more medications to the use of 9 or more medications. Prevalence of women taking two or more medications during pregnancy ranged from 5% to 62%. Majority of the studies were not representative of all pregnancies and excluded pregnancies resulting in miscarriages and terminations. None of the studies report the common combinations of medications taken nor the outcomes for the pregnant women using multiple medications.

Consequences

There isn’t a consensus on the definition of polypharmacy. However, this systematic review shows a relatively large burden of polypharmacy amongst pregnant women. It shows a clear need to assess the combinations of medications used amongst pregnant women and the outcomes for the women and for their offspring, in order to inform both clinicians and patients.

Submitted by:

Astha Anand

Funding acknowledgement:

I am a locally funded academic clinical fellow.