title: Medication adherence among pregnant women with hypothyroidism-missed opportunities to improve reproductive health? A cross-sectional, web-based study.
abstract: To evaluate patterns of and factors associated with a lack of pharmacotherapy as well as low adherence to treatment of hypothyroidism in pregnancy.
  
  
  
  This multinational, cross-sectional, internet-based study recruited pregnant woman in 18 countries. Data about women's socio-demographic and medical characteristics, medication adherence (8-item Morisky Medication Adherence Scale), beliefs about medication (Beliefs about Medicine Questionnaire), and personality traits (Big Five Personality Trait questionnaire) were collected via an online questionnaire.
  
  
  
  229 of 5095 women had hypothyroidism during pregnancy; of these, 93% reported hypothyroidism pharmacotherapy. Adherence was low among 17% (95% CI: 12.5-22.5%) of medicated women, whilst it was moderate and high among 44% and 39%, respectively. Not using folic acid and not living in a stable relationship were associated with an increased likelihood for untreated hypothyroidism. Younger maternal age and not using folic acid in pregnancy were factors significantly associated with low adherence. Conscientiousness and the perception that the benefit of pharmacotherapy outweighed the risks were associated with higher levels of adherence.
  
  
  
  There is room for improvement of adherence to hypothyroidism treatment in pregnancy.
  
  
  
  Counselling of women with hypothyroidism in pregnancy should include a proper risk communication and information framing, to ameliorate maternal and foetal health.
authors.affiliation: Institute of Cell Biology, Histology and Embryology, Medical University of Graz, Graz, Austria; Institute of Human Genetics, Medical University of Graz, Graz, Austria. Electronic address: herbert.juch@medunigraz.at.
authors.forename: Herbert
authors.initials: H
authors.lastname: Juch
authors.affiliation: PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
authors.forename: Angela
authors.initials: A
authors.lastname: Lupattelli
authors.affiliation: PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway; Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway.
authors.forename: Eivind
authors.initials: E
authors.lastname: Ystrom
authors.affiliation: Institute of Human Genetics, Medical University of Graz, Graz, Austria.
authors.forename: Sarah
authors.initials: S
authors.lastname: Verheyen
authors.affiliation: PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway; Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Hedvig
authors.initials: H
authors.lastname: Nordeng
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis* / Q000188:drug therapy*; D020407:Internet; D008423:Maternal Age; D055118:Medication Adherence / Q000523:psychology; D010465:Perception; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy*; D037841:Pregnant People / Q000523:psychology*; D060728:Reproductive Health; D011795:Surveys and Questionnaires; D055815:Young Adult; D016903:Drug Monitoring
keywords: Beliefs about medication; Hypothyroidism; Levothyroxine; Medication adherence; Pregnancy