Adherence to prescription medication during pregnancy: Do pregnant women use pharmacological treatment as prescribed?

Abstract

Aims Pregnant women are hypothesized to have low adherence to prescribed medication, because of concerns about harmful effects on the unborn child. However, very little is known about the actual adherence to prescribed medication during pregnancy. We determined to what extent women follow treatment recommendations regarding prescribed medication use in mid‐pregnancy. Methods Dutch women participating in the PRIDE Study completed a 6‐week diary on medication use. Additionally, pharmacy records were obtained. For each medication dispensed, we determined 3 measures of adherence: (i) whether use was reported in the diary (actual use); (ii) difference between dispensing date and date of first reported use (initiation time); and (iii) proportion of days with at least the correct number of doses taken (implementation adherence). Results During the 6‐week study period, 235 of 816 women (29%) were dispensed medication. Actual use was highest for medications used for chronic conditions (88%; 95% confidence interval [95% CI] 81–93), followed by medication for pregnancy‐related conditions (79%; 95% CI 71–86) and medication for occasional and short‐time use (69%; 95% CI 60–77). We observed a ≥1‐day delay in treatment initiation for 42% of medications dispensed for the first time in the study period. Mean implementation adherence was 74.2% (95% CI 69.3–79.2) for medications that were actually used. Conclusion Although actual use of medications dispensed was high, many pregnant women did not adhere to treatment recommendations. This nonadherence may impact maternal and child health and lead to overestimation of medication use in studies in perinatal pharmacoepidemiology relying on administrative databases.

Acetaminophen Use During Pregnancy and Children’s Risk of Autism, ADHD, and Intellectual Disability

“…This study’s finding that 7.49% of birthing parents used acetaminophen during pregnancy is lower than in some studies, but is concordant with other studies. Self-reported medication use is subject to underreporting of actual use . However, even large amounts of exposure measurement error could not explain the nullification of associations seen with sibling control.…”

“…Self-reported medication use is subject to underreporting of actual use. 35 However, even large amounts of exposure measurement error could not explain the nullification of associations seen with sibling control. Third, this study did not have data on conditions that did not require inpatient or outpatient medical care.…”