Racial/Ethnic Differences in Prenatal Supplement and Medication Use in Low-Risk Pregnant Women

Abstract

Objective This study aimed to describe the overall quantity and type of supplements and medications used during pregnancy in a low-risk cohort and to examine any racial/ethnic differences in intake. Study Design We used data from 2,164 racially/ethnically diverse, nonobese, and low-risk pregnant women participating without pre-pregnancy chronic conditions in a prospective cohort study at 12 sites across the United States. Medication data were self-reported as free text in enrollment, follow-up visit questionnaires, and abstracted from medical records at delivery. Supplements and medications data were mapped to their active ingredients and categorized into corresponding classes using the Slone Drug Dictionary. The total number and classes of supplements and medications consumed during pregnancy were calculated. Modified Poisson regression models were used to estimate the racial/ethnic differences in supplements and medications intake. All models were adjusted for maternal sociodemographic factors and study site. Results 98% of women took at least one supplement during pregnancy, with prenatal vitamins/multivitamins being most common. While only 31% reported taking no medications during pregnancy, 23% took one, 18% took two, and 28% took three or more. The percentage of women taking at least one medication during pregnancy was highest among non-Hispanic white women and lowest among Asians (84 vs. 55%, p < 0.001). All racial/ethnic groups reported taking the same top four medication classes including central nervous system agents, gastrointestinal drugs, anti-infective agents, and antihistamines. Compared with non-Hispanic white women, Hispanic (adjusted relative risk [aRR]: 0.84, 95% confidence interval [CI]: 0.71–0.98), and Asian women (aRR: 0.83, 95% CI: 0.70–0.98) were less likely to take central nervous system agents, as well as gastrointestinal drugs (Hispanics aRR: 0.79, 95% CI: 0.66–0.94; Asians aRR = 0.75, 95% CI: 0.63–0.90), and antihistamines (Hispanics aRR: 0.65, 95% CI: 0.47–0.92). Conclusion Supplement intake was nearly universal. Medication use was also common among this low-risk pregnancy cohort and differed by race/ethnicity. ClinicalTrials.gov Identifier NCT00912132. Key Points

Racial Disparities in Medication Use During Pregnancy: Results from the NISAMI Cohort

“…32 The lower proportion of women who consumed medication during pregnancy among white women found in our study is different from the findings of several previous studies. 8,9,22 Studies have previously demonstrated that limited health literacy and reduced access to healthcare lead to increased self-medication, 33,34 which is commonly practiced by pregnant women due to better accessibility, affordability, and availability of medicines. 35 In this study, medication use included both prescribed drugs and self-medication.…”

“…[36][37][38] Nonetheless, racial differences in medication use prevalence with lower medication use in pregnancy among black women than among women of other races were observed in Brazil and the United States. 8,9,22 Racism leads to socioeconomic disadvantages that extrapolate and extend to health inequities, making access to health services more difficult and increasing the mortality of minority groups. 39 Moreover, institutional racism in health services predominantly affects black people 14 and may result in lower use of medications by black women during pregnancy.…”

“…It acts by blocking H1 receptors in the gastrointestinal tract and decreases stimulation of the vomiting reflex by acting indirectly on the body's vestibular center. 51 A significant variation in the prevalence of antihistamine use during pregnancy has been reported, with antihistamine consumption during pregnancy of 4.5% in Denmark, 52 13.7% in Norway, 5 17.0% in the United States, 22 and 23.3% in Brazil. 9 Approximately 29% of the women analyzed used at least one potentially risky medication during pregnancy, mainly butylscopolamine combined with metamizole and metamizole alone.…”

“…At the same time, previous studies have explored the use of medicines stratified by the race of pregnant women; however, they limited their analysis to specific drug classes, such as opioids, or low-risk pregnant women. 21,22 Moreover, the findings of drug utilization studies can contribute to public health policy decisions and resource allocation 23 which, in this case, could focus on diminishing potential racial disparities in the use of medicines during pregnancy.…”

“…At the same time, previous studies have explored the use of medicines stratified by the race of pregnant women; however, they limited their analysis to specific drug classes, such as opioids, or low-risk pregnant women. 21 , 22 …”