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Prescribed and Non-prescribed Medication Use in Early Pregnancy in a Prospective Cohort of Women

Prescribed and Non-prescribed Medication Use in Early Pregnancy in a Prospective Cohort of Women. Brian J Cleary, Hajeera Butt, Judith Strawbridge, Paul Gallagher, Tom Fahey, Deirdre J Murphy. Introduction. Objectives Determine extent and nature of medication use in early pregnancy

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Prescribed and Non-prescribed Medication Use in Early Pregnancy in a Prospective Cohort of Women

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  1. Prescribed and Non-prescribed Medication Use in Early Pregnancy in a Prospective Cohort of Women Brian J Cleary, Hajeera Butt, Judith Strawbridge, Paul Gallagher, Tom Fahey, Deirdre J Murphy

  2. Introduction • Objectives • Determine extent and nature of medication use in early pregnancy • Explore inappropriate prescribing with potential for fetal harm • Explore prescribing for pre-existing medical disorders. • No large Irish studies conducted • High prevalence of medication use in pregnancy in international studies

  3. Methods • Establishment of dataset • Medications reported at booking interview • Data cleaning and categorisation • Women with antenatal booking interview & delivery suite record 2000-2007 (n=61252)

  4. Results • 4 in 10 women took a medication prior to booking (excluding folic acid) • 1 in 5 women took an OTC product • Most common medications • Analgesics • Antibacterials • Asthma medications • Iron Preparations • Sex hormones

  5. Results Categorisation of medication exposures according to FDA pregnancy category Category D- evidence of fetal risk, benefits may outweigh harm Category X- evidence of fetal risk, any possible benefit outweighed by risk *Medications with no FDA pregnancy category (excludes folic acid, vitamins and minerals)

  6. Results

  7. Factors associated with use of any medication • Age >35y • Booking >20/40 • Unplanned pregnancy* (OR 1.38, 95% CI 1.33, 1.42) • Multiple pregnancy* (OR 1.33, 95% CI 1.17, 1.51) • Single marital status* (OR 1.15, 95% CI 1.11, 1.19) • Smoking in pregnancy* (OR 1.19, 95% CI 1.14, 1.24) • Being a private patient* (OR 1.46, 95% CI 1.41, 1.51) *Odds ratio relative to not having characteristic

  8. Factors associated with use of potentially harmful medication • Booking <12/40 • Being unemployed • Unplanned pregnancy* (OR 1.63, 95% CI 1.47, 1.81) • Single marital status* (OR 2.22, 95% CI 2.00, 2.46) • Multiple pregnancy* (OR 1.56, 95% CI 1.13, 2.13) • Smoking in pregnancy* (OR 3.31, 95% CI 2.98, 3.67) • Publicly funded patient* (OR 1.49, 95% CI 1.32, 1.68) *Odds ratio relative to not having characteristic

  9. Chronic Medical Disorders • Commonly reported disorders • Asthma 9.3% • Depression 9.2% • Hypertension 2.3% • Paroxetine reported in 15.5% of women treated for depression • Atenolol or ACE inhibitors reported by 20.1% of women treated for hypertension

  10. Conclusions • Medication use in early pregnancy is common • Overall level of prescribing of potentially harmful medications low • Some subgroups with suboptimal treatment • Patients with depression treated with paroxetine • Patients with hypertension treated with atenolol / ACE inhibitors • Some subgroups of the population more likely to report medications with potential for fetal harm • Adequate pre-pregnancy counselling essential to ensure optimal medication use in pregnancy • Dataset offers potential for future pregnancy outcome studies

  11. Thank You

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