Evaluation of pharmacotherapy in pregnant patients with a focus on its risks and hypothetical protective factors

Objectives : Pharmacotherapy during pregnancy is considered risky and continues to be a relevant issue. This study aimed to determine how pharmacotherapy in pregnant patients influences pregnancy outcomes in clinical practice and to investigate complex and hypothetical protective factors that contribute to pregnancy outcomes. Material and methods : A retrospective observational study of pregnant patients ( n = 112) was conducted at the Department of Internal Medicine, Teaching Hospital Nitra, in Nitra, Slovak Republic, over a period of 12 years. Clinical outcomes, including the stage of pregnancy, exposure of the embryo/foetus to therapeutic agents, and pregnancy outcomes, were assessed. Results : Among the assessed patients, 82 (73%) used therapeutic agents in the first trimester; the most common use was that of a single therapeutic agent ( n = 44, 39%). Patients most frequently used therapeutic agents from group N: Nervous system ( n = 80 therapeutic agents, 25%). Notably, although half of the patients ( n = 54) used therapeutic agents during the high-risk period for malformation, more than half had healthy newborns ( n = 74, 66%). From a risk perspective, therapeutic agents classified as having no teratogenic potential but that can lead to adverse development of the embryo/foetus were predominant ( n = 92 therapeutic agents, 29%). The presence of hypothetical protective factors capable of weakening and reducing the transfer of substances, therapeutic agents, or metabolites to the embryo/foetus and lowering the potential embryotoxic/foetotoxic effects was observed in 17% of patients in the studied sample who delivered healthy neonates ( n = 76). Conclusion : Pharmacotherapy during pregnancy must be carefully considered and follow the principles of rational pharmacotherapy. Even after exposure to risky pharmacotherapy, more than half of the pregnancies resulted in healthy neonatal outcomes.