title: Women's views on and adherence to low-molecular-weight heparin therapy during pregnancy and the puerperium.
abstract: BACKGROUND
  Non-adherence to prescribed medication represents a significant factor associated with treatment failure. Pregnant women identified at risk of venous thromboembolism are increasingly being prescribed low-molecular-weight heparin (LMWH) during pregnancy and the puerperium. It is important to understand women's views on and adherence to LMWH during pregnancy and the puerperium, so that women gain maximum benefit from the treatment.
  
  
  OBJECTIVE
  To monitor women's adherence to enoxaparin, when prescribed during pregnancy and the puerperium, and explore their beliefs about the enoxaparin therapy prescribed.
  
  
  METHODS
  A prospective cohort study involving 95 nullparous and multiparous women prescribed enoxaparin for recognized antenatal indications. Adherence to enoxaparin was assessed through self-completion of a diary, additionally verified through laboratory tests. An adapted beliefs about medication questionnaire was administered to women during their pregnancy.
  
  
  RESULTS
  Women were highly adherent to enoxaparin: antenatally, mean percentage adherence 97.92%; postnatally, mean percentage adherence 93.37% (paired t-test, P = 0.000). In the cohort of women we followed, their perceived necessity for enoxaparin therapy outweighed any concerns they had regarding enoxaparin antenatally, necessity-concerns differential 2.20. In some women, however, this perceived necessity does decrease postnatally.
  
  
  CONCLUSIONS
  Our results suggest that most women prescribed enoxaparin are highly adherent to their therapy during the antenatal period and that women's antenatal beliefs about enoxaparin are able to predict a decrease in postnatal adherence. Our results have important clinical implications, particularly when women are initiated on LMWH just during the postnatal period.
authors.affiliation: King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital Foundation NHS Trust, London, UK. jig.patel@kcl.ac.uk
authors.forename: J P
authors.initials: JP
authors.lastname: Patel
authors.forename: V
authors.initials: V
authors.lastname: Auyeung
authors.forename: R K
authors.initials: RK
authors.lastname: Patel
authors.forename: M S
authors.initials: MS
authors.lastname: Marsh
authors.forename: B
authors.initials: B
authors.lastname: Green
authors.forename: R
authors.initials: R
authors.lastname: Arya
authors.forename: J G
authors.initials: JG
authors.lastname: Davies
mesh_terms: D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D010349:Patient Compliance; D049590:Postpartum Period; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D054556:Venous Thromboembolism / Q000150:complications / Q000188:drug therapy*
chemical_list: D006495:Heparin, Low-Molecular-Weight