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Prescription and Other Medication Use in Pregnancy

Haas, David, M., MD, MS; Marsh, Derek, J., MS; Dang, Danny, T., MD; Parker, Corette, B., DrPH; Wing, Deborah, A., MD, MBA; Simhan, Hyagriv, N., MD; Grobman, William, A., MD, MBA; Mercer, Brian, M., MD; Silver, Robert, M., MD; Hoffman, Matthew, K., MD; Parry, Samuel, MD; Iams, Jay, D., MD; Caritis, Steve, N., MD; Wapner, Ronald, J., MD; Esplin, M., Sean, MD; Elovitz, Michal, A., MD; Peaceman, Alan, M., MD; Chung, Judith, MD; Saade, George, R., MD; Reddy, Uma, M., MD, MPH

doi: 10.1097/AOG.0000000000002579
Contents: Drugs in Pregnancy: Original Research

OBJECTIVE: To characterize prescription and other medication use in a geographically and ethnically diverse cohort of women in their first pregnancy.

METHODS: In a prospective, longitudinal cohort study of nulliparous women followed through pregnancy from the first trimester, medication use was chronicled longitudinally throughout pregnancy. Structured questions and aids were used to capture all medications taken as well as reasons they were taken. Total counts of all medications taken including number in each category and class were captured. Additionally, reasons the medications were taken were recorded. Trends in medications taken across pregnancy and in the first trimester were determined.

RESULTS: Of the 9,546 study participants, 9,272 (97.1%) women took at least one medication during pregnancy with 9,139 (95.7%) taking a medication in the first trimester. Polypharmacy, defined as taking at least five medications, occurred in 2,915 (30.5%) women. Excluding vitamins, supplements, and vaccines, 73.4% of women took a medication during pregnancy with 55.1% taking one in the first trimester. The categories of drugs taken in pregnancy and in the first trimester include the following: gastrointestinal or antiemetic agents (34.3%, 19.5%), antibiotics (25.5%, 12.6%), and analgesics (23.7%, 15.6%, which includes 3.6%; 1.4% taking an opioid pain medication).

CONCLUSION: In this geographically and ethnically diverse cohort of nulliparous pregnant women, medication use was nearly universal and polypharmacy was common.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01322529.

Nearly all pregnant women take at least one medication during pregnancy, with almost one third meeting the definition of polypharmacy.

Department of Obstetrics and Gynecology, Indiana University, Indianapolis, Indiana; RTI International, Washington, DC; the University of California–Irvine, Irvine, California; the University of Pittsburgh, Pittsburgh, Pennsylvania; Northwestern University, Chicago, Illinois; Case Western Reserve University, Cleveland, Ohio; the University of Utah, Salt Lake City, Utah; Christiana Care, Christiana, Delaware; the University of Pennsylvania, Philadelphia, Pennsylvania; The Ohio State University, Columbus, Ohio; Columbia University, New York, New York; the University of Texas Medical Branch, Galveston, Texas; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.

Corresponding author: David M. Haas, MD, MS, Department of Obstetrics and Gynecology, Indiana University School of Medicine, 550 N University Boulevard, UH 2440, Indianapolis, IN 46202; email: dahaas@iupui.edu.

Supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U10 HD063036, RTI International; U10 HD063072, Case Western Reserve University; U10 HD063047, Columbia University; U10 HD063037, Indiana University; U10 HD063041, University of Pittsburgh; U10 HD063020, Northwestern University; U10 HD063046, University of California–Irvine; U10 HD063048, University of Pennsylvania; and U10 HD063053, University of Utah. In addition, support was provided by respective Clinical and Translational Science Institutes to Indiana University (UL1TR001108) and the University of California–Irvine (UL1TR000153).

Financial Disclosure The authors did not report any potential conflicts of interest.

Comments and views of the authors do not necessarily represent views of the National Institutes of Health.

The authors thank Amber Lee, BS, for her assistance with adjudication of medication codes for the data set.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.