Medications and pregnancy: The role of community pharmacists – A descriptive study

Abstract

BackgroundSafe use of medications during pregnancy requires a comprehensive understanding of risk-benefit profiles for individual treatments. Pharmacists are supported in this aspect by clinical information agencies (e.g. MotherSafe, a telephone-based teratogen information service) and reference texts. To what extent and for what reasons Australian pharmacists utilise these services/resources are yet unknown. Further, debate on replacement of conventionally defined medication safety in pregnancy categories (A, B1-3, C, D, X) by narratively stated safety evidence may affect pharmacists’ routine practice. This study aimed to gauge pharmacists’ experiences and resource needs in undertaking support roles regarding gestational drug use.MethodsSemi-structured interviews (audio-recorded or documented using field notes) were performed with community pharmacists in Australia and transcribed verbatim. Inductive thematic analysis was conducted using the NVivo software (Version 11, QSR International).ResultsData saturation was achieved with 24 interviews. Qualitative data yielded 5 emergent themes: barriers to effective counselling, patient trust, risk perception, role definition and practice support needs. Overall, participants relied on pregnancy categories, were risk averse and cautious in offering advice. Currently available data for unclassified and category B therapeutic agents (limited human data) were deemed inadequate. Reluctance to use the proposed narrative system was also expressed.DiscussionThis study highlights key barriers in the provision of maternal care by pharmacists and the potential tension present if the existing category system is replaced by a narrative one. These need to be addressed through training and development of practice support resources to enhance pharmacists’ skills in evidence-based risk estimation and communication.

Utilisation of a NSW teratology information service by pharmacists and patients referred by a pharmacist from 2000 to 2018

“…Almost twice as many patients sought more advice regarding medications with risk category A compared to pharmacists themselves. Although in general, clinical hesitancy about counselling pregnant women about drugs was subliminally evident in a previous qualitative study with Australian pharmacists, pharmacists in the study still appeared reasonably confident in counselling women about drugs in categories A, D and X, where they probably felt the evidence supporting the allocation of that particular category was straightforward . Analysis of MotherSafe calls in this study reinforced this finding regarding pharmacists’ confidence in counselling about drugs in category A.…”

“…Although pharmacists profess a need for succinct information, the A–X categorisation of drugs in pregnancy should not be used as the definitive resource in prescribing medications in pregnancy, for women planning to conceive or those breastfeeding, as categories do not apply to the latter. However, unfortunately, pharmacists rely heavily upon the letter categories (which are included in prescribing references as well as in product and consumer medicines information) when managing pregnant patients . Misuse of categories can result in significant harm including undue anxiety due to heightened perception of risk and cessation of needed medications on supposed fetal safety grounds, thereby potentially compromising both the mother's and baby's health.…”

“…A recent qualitative study also described significant uncertainty among community pharmacists in providing advice to pregnant women regarding uncategorised medications despite being some of the main suppliers of complementary medicines . An analysis of complementary medicine use by pregnant women indicates that there is often potential for significant drug–herb interactions as many women also use conventional medicines, not to mention concerns about the purity of the compounds and paucity of evidence‐based data about their efficacy .…”

Pharmacists and Contraception in the Inpatient Setting

“…This can prevent medication misuse and prevent patients from potentially seeking information from unreliable sources. If a patient is initiated on a teratogenic medication while hospitalized, an inpatient clinical pharmacist can assist in counseling the patient regarding the risks and benefits of the medication as well as appropriate contraceptive use to prevent pregnancy [49]. Advanced drug-pregnancy alerts can be implemented by organizations to alert inpatient pharmacists when hospitalized patients may be or are pregnant, and these may be particularly helpful when deciding whether to initiate teratogenic medications.…”

Perceived Services and Reported Opinions about Self-Care during Pregnancy and Lactation by Community Pharmacists: A Cross Sectional Study

“…The International Pharmaceutical Federation Council (2011) approved an article about the role of the pharmacist to deal with the special population which states guidelines on Good Pharmacy Practice to ameliorate the health of pregnant and lactating women [13]. Many studies are carried out to define the role of community pharmacists to deal with special population sickness in USA, Canada, Iceland, Kuwait, Norway, Thailand, Uganda, and Qatar [14][15][16][17][18]. Most of these studies evaluated the pharmacist's responses to treat symptoms observed during pregnancy and lactation to advice and counsel the special population along with their recommendations and knowledge about medications.…”