Drug use before and during pregnancy in Serbia
- 291 Downloads
Background Observation of drug use patterns during pregnancy is necessary for the recognition of potential bad practices and improvement of safe drug use in pregnancy. Objective To investigate prescription and over the counter drug use among Serbian women in the 6 months before pregnancy and in the first 6 months of pregnancy, and to evaluate the drugs used according to the risk to a fetus. Setting Six maternity care units and five community pharmacies Method A multi-center study was performed in Serbia during the period from March 2009–March 2010. A self-reporting questionnaire was used as a data source. Food and Drug Administration (FDA) risk classification system was used to determine the risk of used drugs for the fetus. Differences between subgroups were assessed using McNemar’s test on paired proportions. Main outcome measure Proportion of women exposed to drugs or class of drugs. Results The overall drug exposure was higher in pregnancy (34.7 %) than before pregnancy (29.9 %), p > 0.05, in the cohort of 311 pregnant women. A significantly greater prescription drug use, 19.0 versus 27.3 % of women, p < 0.05, and less selfmedication with over the counter drugs in pregnancy, 15.1 versus 8.7 %, p < 0.05, were observed. Commonly used drugs were musculoskeletal drugs, analgesics/antipyretics and respiratory system drugs before pregnancy (13.8, 12.5, and 6.4 % of women, respectively), and progestogens, analgesics/antipyretics, and antibiotics for the systemic use in pregnancy (9.0, 7.7, and 7.4 %, respectively). A greater exposure to drugs belonging to the FDA risk category A (3.9 vs. 60.8 %, p < 0.05), B (18.0 vs. 19.6 %, p > 0.05), C (10.0 vs. 10.3 %, p > 0.05) and D (2.9 vs. 10.9 %, p < 0.05), as well as less exposure to drugs belonging to category X (0.3 vs. 0 %, p > 0.05) were observed in pregnancy. Folic acid was used by 60.8 % of women in pregnancy, and by only 3.9 % before pregnancy. Conclusion Besides higher overall drug use in pregnancy than before pregnancy, particularly the use of progestogens, and, subsequently, D category drugs, less selfmedication with over the counter drugs was observed in pregnancy. Insufficient use of folic acid before pregnancy requires public health service activities.
KeywordsDrug use FDA pregnancy risk classification OTC medication Pregnancy Serbia
We are very grateful to the Associate Professor Natasa Bogavac Stanojevic, the University of Belgrade-Faculty of Pharmacy for her useful comments in the statistical analysis, to the Associate Professor Hedvig Nordeng, School of Pharmacy, the University of Oslo, for her comments and to Mr. David Jones and Mrs. Zorica Bogdanovic for editing of the English. We are grateful to all the mothers, nurses and pharmacists who participated and cooperated in this study.
This work is supported by the Ministry of Education and Science, Republic of Serbia, Project No. 41012, and Project No. 175064, 2011-2014.
Conflicts of interest
The authors declare no conflict of interest.
- 3.Adam MP, Polifka JE, Friedman JM. Evolving knowledge of the teratogenicity of medications in human pregnancy. Am J Med Genet C Semin Med Genet. 2011;157C(3):175–82.Google Scholar
- 6.World Health Organization. Body mass index classification. Available at: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. Accessed on 09 June 2012.
- 7.World Health Organization. ATC/DDD index 2012. Available at: http://www.whocc.no/atc_ddd_index/. Accessed on 10 June 2012.
- 8.Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation: A reference guide to fetal and neonatal risk. 8th ed. Philadelphia: Lippincott Wiliams & Wilkins; 2008. ISBN: 978-0-7817-7876-3.Google Scholar
- 9.Sipetic T. National formulary. Belgrade: Medicines and Medical Devices Agency of Serbia; 2010.Google Scholar
- 18.Nordeng H, Eskild A, Nesheim BI, Jacobsen G. Drug use in pregnancy among parous Scandinavian women. Norsk Epidemiologi. 2001;11:97–103.Google Scholar
- 22.Thach TS. Progestogen for preventing miscarriage: RHL commentary. World Health Organization; 2009. Available at: http://apps.who.int/rhl/pregnancy_childbirth/antenatal_care/miscarriage/cd003511_thacht/en/index.html. Assessed on 09 June 2012.
- 23.Haas DM, Ramsey PS. Progestogen for preventing miscarriage. Cochrane Database Sys Rev. 2008;2:CD003511.Google Scholar
- 25.De-Regil LM, Fernández-Gaxiola AC, Dowswell T, Peńa-Rosas JP. Effects and safety of periconceptional folate supplementation for preventing birth defects. Cochrane Database Syst Rev. 2010;10:007950.Google Scholar
- 26.European surveillance of congenital anomalies special report: prevention on neural tube defect by periconceptual folic acid supplementation in Europe. Available at: http://www.eurocat-network.eu/content/Special-Report-NTD-3rdEd-Part-I.pdf. Accessed on 10 June 2012.
- 31.Daw JR, Hanley GE, Greyson DL, Morgan SG. Prescription drug use during pregnancy in developed countries: a systematic review. Pharmacoepidemiol Drug Saf. 2010;20(9):895–902.Google Scholar
- 33.Ministry of health republic of Serbia. National health survey. Key findings. 2006. Available at: http://www.batut.org.rs/index.php?content=59. Accessed on 10 June 2012.