title: Patterns and factors associated with low adherence to psychotropic medications during pregnancy--a cross-sectional, multinational web-based study.
abstract: BACKGROUND
  No previous studies have explored how closely women follow their psychotropic drug regimens during pregnancy. This study aimed to explore patterns of and factors associated with low adherence to psychotropic medication during pregnancy.
  
  
  METHODS
  Multinational web-based study was performed in 18 countries in Europe, North America, and Australia. Uniform data collection was ensured via an electronic questionnaire. Pregnant women were eligible to participate. Adherence was measured via the 8-item Morisky Medication Adherence Scale (MMAS-8). The Beliefs about Prescribed Medicines Questionnaire (BMQ-specific), the Edinburgh Postnatal Depression Scale (EPDS), and a numeric rating scale were utilized to measure women's beliefs, depressive symptoms, and antidepressant risk perception, respectively. Participants reporting use of psychotropic medication during pregnancy (n = 160) were included in the analysis.
  
  
  RESULTS
  On the basis of the MMAS-8, 78 of 160 women (48.8%, 95% CI: 41.1-56.4%) demonstrated low adherence during pregnancy. The rates of low adherence were 51.3% for medication for anxiety, 47.2% for depression, and 42.9% for other psychiatric disorders. Smoking during pregnancy, elevated antidepressant risk perception (risk≥6), and depressive symptoms were associated with a significant 3.9-, 2.3-, and 2.5-fold increased likelihood of low medication adherence, respectively. Women on psychotropic polytherapy were less likely to demonstrate low adherence. The belief that the benefit of pharmacotherapy outweighed the risks positively correlated (r = .282) with higher medication adherence.
  
  
  CONCLUSIONS
  Approximately one of two pregnant women using psychotropic medication demonstrated low adherence in pregnancy. Life-style factors, risk perception, depressive symptoms, and individual beliefs are important factors related to adherence to psychotropic medication in pregnancy.
authors.affiliation: School of Pharmacy, University of Oslo, Oslo, Norway.
authors.forename: Angela
authors.initials: A
authors.lastname: Lupattelli
authors.affiliation: Department of Clinical Pharmacology, St. Olav's University Hospital, Trondheim, Norway.|Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Olav
authors.initials: O
authors.lastname: Spigset
authors.affiliation: School of Pharmacy, University of Oslo, Oslo, Norway.
authors.forename: Ingunn
authors.initials: I
authors.lastname: Björnsdóttir
authors.affiliation: Finnish Medicines Agency, Kuopio, Finland.
authors.forename: Katri
authors.initials: K
authors.lastname: Hämeen-Anttila
authors.affiliation: Research and Development, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Ann-Charlotte
authors.initials: AC
authors.lastname: Mårdby
authors.affiliation: School of Pharmaceutical Sciences, University of Geneva and Lausanne, Geneva, Switzerland.
authors.forename: Alice
authors.initials: A
authors.lastname: Panchaud
authors.affiliation: Children's Hospital Srebrnjak, Neuropediatric Unit, Zagreb, Croatia.
authors.forename: Romana Gjergja
authors.initials: RG
authors.lastname: Juraski
authors.affiliation: Clinical Institute of Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Gorazd
authors.initials: G
authors.lastname: Rudolf
authors.affiliation: Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia.
authors.forename: Marina
authors.initials: M
authors.lastname: Odalovic
authors.affiliation: Faculty of Pharmacy, Medical University of Lublin, Lublin, Poland.
authors.forename: Mariola
authors.initials: M
authors.lastname: Drozd
authors.affiliation: School of Pharmacy, University of East Anglia, Norwich Research Park, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Twigg
authors.affiliation: Research Unit Human Teratogens, Institute for Cell Biology, Histology and Embryology, Medical University of Graz, Graz, Austria.
authors.forename: Herbert
authors.initials: H
authors.lastname: Juch
authors.affiliation: The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: Myla E
authors.initials: ME
authors.lastname: Moretti
authors.affiliation: MotherSafe, Royal Hospital for Women and University of NSW, Randwick, Australia.
authors.forename: Debra
authors.initials: D
authors.lastname: Kennedy
authors.affiliation: APHP, GH HUPS, Hop Antoine Béclère, Service Pharmacie, Clamart France and Européenne de Formation pour les Pharmaciens, France.
authors.forename: Andre
authors.initials: A
authors.lastname: Rieutord
authors.affiliation: Northwest Medical Center for Drug Safety in Pregnancy & Lactation, Northwest State Medical University n.a.I.I.Mechnikov, St. Petersburg, Russia.
authors.forename: Ksenia
authors.initials: K
authors.lastname: Zagorodnikova
authors.affiliation: Teratology Information Service (TIS), Netherlands Pharmacovigilance Centre Lareb, The Netherlands.
authors.forename: Anneke
authors.initials: A
authors.lastname: Passier
authors.affiliation: School of Pharmacy, University of Oslo, Oslo, Norway.|Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Hedvig
authors.initials: H
authors.lastname: Nordeng
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000188:drug therapy / Q000523:psychology; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003469:Culture; D003866:Depressive Disorder / Q000188:drug therapy / Q000523:psychology; D005260:Female; D006801:Humans; D020407:Internet; D055118:Medication Adherence; D001523:Mental Disorders / Q000188:drug therapy* / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000523:psychology*; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs
keywords: adherence; antidepressants; anxiety; depression; pharmacotherapy; pregnancy