Key result
During the first trimester, 24.6% of pregnancies were exposed to polypharmacy (2+ medications), and this prevalence increased significantly over the two-decade study period.
Why the study?
Medication use during pregnancy has risen, but few studies have described the prevalence of multiple medication use among pregnant women.
Cohort (n=1,521,317)
Yes
The prevalence of polypharmacy during pregnancy in the UK has increased significantly over the past two decades, highlighting the need for pharmaco-epidemiological research on fetal safety.
Answers are grounded in this paper and cite their sources.
Rising polypharmacy in UK pregnancies signals need for clinical monitoring in high-risk groups; leaves open fetal safety questions for dedicated pharmacoepidemiologic research.
BACKGROUND: The number of medications prescribed during pregnancy has increased over the past few decades. Few studies have described the prevalence of multiple medication use among pregnant women. This study aims to describe the overall prevalence over the last two decades among all pregnant women and those with multimorbidity and to identify risk factors for polypharmacy in pregnancy. METHODS: A retrospective cohort study was conducted between 2000 and 2019 using the Clinical Practice Research Datalink (CPRD) pregnancy register. Prescription records for 577 medication categories were obtained. Prevalence estimates for polypharmacy (ranging from 2+ to 11+ medications) were presented along with the medications commonly prescribed individually and in pairs during the first trimester and the entire pregnancy period. Logistic regression models were performed to identify risk factors for polypharmacy. RESULTS: During the first trimester (812,354 pregnancies), the prevalence of polypharmacy ranged from 24.6% (2+ medications) to 0.1% (11+ medications). During the entire pregnancy period (774,247 pregnancies), the prevalence ranged from 58.7 to 1.4%. Broad-spectrum penicillin (6.6%), compound analgesics (4.5%) and treatment of candidiasis (4.3%) were commonly prescribed. Pairs of medication prescribed to manage different long-term conditions commonly included selective beta 2 agonists or selective serotonin re-uptake inhibitors (SSRIs). Risk factors for being prescribed 2+ medications during the first trimester of pregnancy include being overweight or obese [aOR: 1.16 (1.14-1.18) and 1.55 (1.53-1.57)], belonging to an ethnic minority group [aOR: 2.40 (2.33-2.47), 1.71 (1.65-1.76), 1.41 (1.35-1.47) and 1.39 (1.30-1.49) among women from South Asian, Black, other and mixed ethnicities compared to white women] and smoking or previously smoking [aOR: 1.19 (1.18-1.20) and 1.05 (1.03-1.06)]. Higher and lower age, higher gravidity, increasing number of comorbidities and increasing level of deprivation were also associated with increased odds of polypharmacy. CONCLUSIONS: The prevalence of polypharmacy during pregnancy has increased over the past two decades and is particularly high in younger and older women; women with high BMI, smokers and ex-smokers; and women with multimorbidity, higher gravidity and higher levels of deprivation. Well-conducted pharmaco-epidemiological research is needed to understand the effects of multiple medication use on the developing foetus.
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Subramanian et al. (2023) conducted a cohort in Pregnancy (n=1,521,317). Polypharmacy (2+ medications) vs. Fewer than 2 medications was evaluated on Prevalence of polypharmacy (2+ medications) during the first trimester (95% CI 24.6-24.6). During the first trimester, 24.6% of pregnancies were exposed to polypharmacy (2+ medications), and this prevalence increased significantly over the two-decade study period.
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