Publications

Introduction

Pregnancy is an alteration of the normal physiological process requiring special and organized medical attention. Antenatal care is an organized medical service with the end objective of achieving the delivery of a healthy baby without impairing the health of the mother. The usage of medications during pregnancy is expected to help to achieve this outcome. The proportion of pregnant women receiving drugs excluding iron and folic acid during pregnancy varies from 38.4% to 61.8%.1, 2 This could be due to infections, hemorrhage, anemia, and pre-eclampsia arising as a result of pregnancy or due to an established illness of the mother that requires treatment.3 Pharmacotherapy of these conditions can reduce perinatal morbidity and mortality.

However, pregnancy management using medications has been challenging for both healthcare providers and pregnant women due to the fear of teratogenic effects. For example, thalidomide which was given as a treatment for hyperemesis gravidarum was later found to cause phocomelia on exposure to the fetus during the first trimester.4 Similarly, use of non-steroidal anti-inflammatory drugs (NSAIDs) during the first trimester increases risk of miscarriage and malformation (e.g., gastroschisis).5

Besides teratogenicity, fetal vulnerability to drug pharmacodynamics and resulting toxicity is also a concern. Pharmacokinetics and pharmacodynamics vary during pregnancy. Factors that may alter pharmacokinetics and pharmacodynamics during pregnancy include changes in weight, body composition, pregnancies with multiples (e.g., twins, triplets), increased blood volume, and abrupt changes in behaviors such as alcohol and tobacco use.6–8

In order to optimize medical management during pregnancy and to guide safe drug use, the U.S. Food and Drug Administration (FDA) classified drugs into five major categories A, B, C, D, and X, with categories D and X indicating evidence of risk in pregnancy.9, 10

Extent of drug use during pregnancy is also not very well known. The maternal mortality in India has also remained high at 130/1,00,000 while in Karnataka it is 108/1,00,000 (2014–2016).11 Studies which report the patterns and extent of medication use in pregnancy, maternal factors that influence medication use, together with the outcomes of pregnancy, are limited, especially from developing countries like India to the best of our knowledge. We searched using the MeSH terms pregnancy, drug utilization, determinants of prescription and outcomes in PubMed from 2000 to 2022.

The primary objective of the study was to study the patterns of medication use during antenatal period and evaluate the factors influencing drug prescription in pregnancy. The secondary objectives of the study were to describe the drugs prescribed during labor and postpartum period and to describe the neonatal and maternal outcomes observed.