Medication use in early pregnancy-prevalence and determinants of use in a prospective cohort of women.
OBJECTIVE
To examine the extent, nature and determinants of medication use in early pregnancy.


METHODS
We reviewed early pregnancy medication use, as reported to a midwife at the booking interview, in women delivering between 2000 and 2007 in a large maternity hospital in Dublin, Ireland (n = 61 252).


RESULTS
Excluding folic acid, at least one medication was reported in 23 989 (39.2%) pregnancies. Over the counter (OTC) medications were reported in 11 970 (19.5%) pregnancies, illicit drugs or methadone in 545 (0.9%) and herbal medicines/supplements in 352 (0.58%). FDA category D and X medications were reported by 1532 (2.5%) and 1987 (3.2%) women. Asthma, depression and hypertension were among the most commonly reported chronic medical disorders. Medications with potential for foetal harm were reported by 86 (15.7%) women treated for depression and 68 (20%) women treated for hypertension. Factors associated with reporting the use of medications with potential for foetal harm included unplanned pregnancy (adjusted odds ratio [aOR] 1.31, 95% confidence interval [CI] 1.12-1.52), booking at less than 12 weeks gestation (aOR 1.83, 95%CI 1.58-2.13), being above 25 years of age, unemployed (aOR 2.58, 95%CI 2.03-3.29), nulliparous (aOR 1.41; 95%CI 1.22-1.63), single (aOR 1.28; 95%CI 1.06-1.54) or smoking during pregnancy (aOR 1.96, 95%CI 1.67-2.28).


CONCLUSIONS
Women frequently report medication use in early pregnancy. Women and prescribers need to be aware of the lack of pregnancy safety data for many medications, and the need for pre-pregnancy planning. Prescribers should ensure that optimal medications are used when treating women of childbearing potential with chronic medical disorders.
Cleary
Brian J
BJ
Coombe Women and Infants University Hospital, Dublin, Republic of Ireland. bcleary@coombe.ie
Butt
Hajeera
H
Strawbridge
Judith D
JD
Gallagher
Paul J
PJ
Fahey
Tom
T
Murphy
Deirdre J
DJ
D000328:Adult; D015331:Cohort Studies; D017723:Drug Utilization Review / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D047109:Fetal Development / Q000187:drug effects; D005865:Gestational Age; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects; D004364:Pharmaceutical Preparations / Q000008:administration & dosage / Q000145:classification; D028321:Plant Preparations / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D055553:Prescription Drugs / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015995:Prevalence; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014481:United States; D014486:United States Food and Drug Administration; D055815:Young Adult
D013287:Illicit Drugs; D004364:Pharmaceutical Preparations; D028321:Plant Preparations; D055553:Prescription Drugs