title: Drug use before and during pregnancy in Serbia.
abstract: BACKGROUND
  Observation of drug use patterns during pregnancy is necessary for the recognition of potential bad practices and improvement of safe drug use in pregnancy.
  
  
  OBJECTIVE
  To investigate prescription and over the counter drug use among Serbian women in the 6 months before pregnancy and in the first 6 months of pregnancy, and to evaluate the drugs used according to the risk to a fetus. Setting Six maternity care units and five community pharmacies.
  
  
  METHODS
  A multi-center study was performed in Serbia during the period from March 2009-March 2010. A self-reporting questionnaire was used as a data source. Food and Drug Administration (FDA) risk classification system was used to determine the risk of used drugs for the fetus. Differences between subgroups were assessed using McNemar's test on paired proportions. Main outcome measure Proportion of women exposed to drugs or class of drugs.
  
  
  RESULTS
  The overall drug exposure was higher in pregnancy (34.7 %) than before pregnancy (29.9 %), p > 0.05, in the cohort of 311 pregnant women. A significantly greater prescription drug use, 19.0 versus 27.3 % of women, p < 0.05, and less selfmedication with over the counter drugs in pregnancy, 15.1 versus 8.7 %, p < 0.05, were observed. Commonly used drugs were musculoskeletal drugs, analgesics/antipyretics and respiratory system drugs before pregnancy (13.8, 12.5, and 6.4 % of women, respectively), and progestogens, analgesics/antipyretics, and antibiotics for the systemic use in pregnancy (9.0, 7.7, and 7.4 %, respectively). A greater exposure to drugs belonging to the FDA risk category A (3.9 vs. 60.8 %, p < 0.05), B (18.0 vs. 19.6 %, p > 0.05), C (10.0 vs. 10.3 %, p > 0.05) and D (2.9 vs. 10.9 %, p < 0.05), as well as less exposure to drugs belonging to category X (0.3 vs. 0 %, p > 0.05) were observed in pregnancy. Folic acid was used by 60.8 % of women in pregnancy, and by only 3.9 % before pregnancy.
  
  
  CONCLUSIONS
  Besides higher overall drug use in pregnancy than before pregnancy, particularly the use of progestogens, and, subsequently, D category drugs, less selfmedication with over the counter drugs was observed in pregnancy. Insufficient use of folic acid before pregnancy requires public health service activities.
authors: Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, The University of Belgrade, Vojvode Stepe 450, 11221 Belgrade, Serbia.
authors: Marina
authors: M
authors: Odalovic
authors: Sandra
authors: S
authors: Vezmar Kovacevic
authors: Katarina
authors: K
authors: Ilic
authors: Ana
authors: A
authors: Sabo
authors: Ljiljana
authors: L
authors: Tasic
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D011247:Pregnancy / Q000187:drug effects / Q000208:ethnology*; D012651:Self Medication / Q000379:methods; D057566:Self Report; D055771:Serbia / Q000208:ethnology; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D004364:Pharmaceutical Preparations