Background Maternal drug use in pregnancy is a health care issue of major concern as most drugs are used with limited knowledge of safety and efficacy for the mother, have undetermined risks, and potential adverse effects on the fetus. Recent epidemiological data are insufficient to evaluate their licensed status and use during pregnancy.
The aim of the present review is to provide a recent up-date on the use of medications during gestational period and determine the circumstances of this consumption in terms of prescription/automedication, according to label or off-label use.
Methods MEDLINE and Embase databases were used to select peer reviewed journal articles published between 1990 and 2016. The search included the keywords: preg-nancy, drug, medication, prescription, over-the-counter and automedication. Only epidemiological studies ana-lyzing the overall use of drugs (prescribed drugs, medi-cation available over-the-counter, vitamins and other supplements) among pregnant women were included, both international and national/regional, excluding those focusing on a specific therapeutic category.
Results The screening process led to a final selection of 77 studies, conducted in 28 different countries (2 studies were from Oceania, 9 from Africa, 14 from Asia, 18 from America, and 31 studies from Europe). The investigated period was remarkably different and ranged from a one month to 33 years with information collected at differ-ent time periods from 1976 to 2014. Sample sizes were also very variable between studies from 100 to 1 106 757 included women. Overall drug consumption was highly different among countries ranging from 17.6% to 93.9% when vitamins, minerals and other supplements were excluded. Of all the studies reporting the percentage of women using drugs during pregnancy (n=58, 75.3%), 21 studies (36%) (among 2 38 731 women) reported that more than 90% of women took one or more drugs while being pregnant. Folic acid, iron supplements and vita-mins were in most countries the most frequently used therapeutic category. Analgesics, antibiotics and other anti-infectives were also used extensively. Nineteen stud-ies reported data on automedication with an important variability in prescription/over-the-counter medicines ratio among studies. Information about off-label prescrip-tion was rarely reported.
Conclusion The use of drugs is frequent during preg-nancy. Comparisons of medication exposure rates and characteristics of drug consumption were difficult due to the observed heterogeneity of methodology, type of drugs reported or data sources. Standardised reports and analyses of drug consumption during pregnancy are needed to contribute to this issue of major public health importance. Recommendations have been made on the main criteria that should be taken into consideration when carrying out an epidemiology study on drug use during pregnancy.
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