Self-Reported Medication Use among Pregnant and Breastfeeding Women during the COVID-19 Pandemic: A Cross-Sectional Study in Five European Countries

Abstract

Insight into the epidemiology of perinatal medication use during the COVID-19 pandemic is scarce. Therefore, a cross-sectional study using an anonymous web survey was performed in Ireland, Norway, Switzerland, the Netherlands, and United Kingdom (UK) to investigate the prevalence and type of medications used by pregnant and breast-feeding women during the first pandemic wave. Factors associated with medication use were estimated by logistic regression. In total, 8378 women participated (i.e., 3666 pregnant and 4712 breastfeeding women). Most responses were collected in Norway (34%) and the Netherlands (28%), followed by Switzerland (19%), Ireland (17%) and UK (2%). Participants were more often professionally active and more often had a higher educational level compared to the general birthing population in each country. Overall, approximately 60% of women reported having used at least 1 medication in the preceding 3 months. Daily and occasional use was reported by 34% and 42% of pregnant and 29% and 44% of breastfeeding women. The most prevalent ATC (Anatomical Therapeutic Chemical) categories were the nervous system, the respiratory system, the alimentary tract/metabolism, and the musculo-skeletal system. Paracetamol, ibuprofen, antacids, and cetirizine were the most frequently used medications. The rate of antibacterial use was lower than previously reported. Having a chronic illness, country, maternal age, SARS-CoV-2 testing, professional status and time since delivery were associated with medication use. In conclusion, perinatal medication use was highly prevalent during the first pandemic wave, underlining the importance of maintaining counseling efforts on medication use, even in times of disrupted healthcare services and/or limited resources.

Registered Clinical Trials Comprising Pregnant Women in China: A Cross-Sectional Study

“…Clinical trials are critical to clinical practice and decision-making ( Mastroianni and Kahn, 2001 ). However, pregnant women were excluded from the majority of drug trials ( Mofenson et al, 2019 ), yet other very relevant and/or more recent references of “drug utilization” studies could be used to show that pregnant women often (need to) use medication ( Lupattelli et al, 2014 ; Ceulemans et al, 2022 ). As several investigators have determined, most trials have been funded by large pharmaceutical concerns that had better financial and organizational resources and more experts in conducting trials ( Laterre and François, 2015 ).…”

Self-Reported Medication Use among Pregnant and Postpartum Women during the Third Wave of the COVID-19 Pandemic: A European Multinational Cross-Sectional Study

“…An online, anonymous questionnaire was distributed in Norway, Belgium, Switzerland, the Netherlands, and the United Kingdom between 10 June and 22 August 2021 (see Supplementary Materials S1 for the English version). The questionnaire was adapted from the first round of the COVID-19 project in 2020 [2,23,24]. Pregnant women and women who had given birth in the three months preceding the survey and who were at least 18 years old, were eligible to participate.…”

“…While evidence on medication practices and utilization patterns in the general population during the pandemic is continuously growing, it remains scarce among pregnant and postpartum women. A multinational study performed across five European countries at the end of the first wave of the pandemic (i.e., June-July 2020) reported on the use of medication in this specific population [23]. Results showed a high prevalence of self-reported medication use (60%), with similar medication classes being frequently used during the pandemic as before, except for the level of antibiotic use.…”

Comment to “Pregnancy and COVID-19, focus on vaccine and pharmacological treatment”

“…We read with interest the short communication on COVID-19 and pregnancy by Vitiello and colleagues ( Vitiello et al, 2022 ), and thank the authors for referring to our earlier published manuscript on medication use among pregnant and breastfeeding women in Europe during the COVID-19 pandemic ( Ceulemans et al, 2022 ). However, we would like to comment on a misleading statement in their publication, and their inadequate reference to our manuscript used to substantiate this statement.…”

“…Other potential complications caused by NSAID use late in pregnancy are an increased risk of premature closure of the ductus arteriosus and pulmonary hypertension in the newborn, decrease in labor activity and delay of childbirth, and increased bleeding risk ( Antonucci et al, 2012 ). We referred to this in our discussion, highlighting that the use of “some medicines, such as ibuprofen after 20 weeks gestational age, may have detrimental effects on the developing fetus” ( Ceulemans et al, 2022 ) , and should therefore be avoided in this population. In conclusion, NSAIDs should not be taken in pregnancy to treat minor symptoms of COVID-19 or any other indication without having a proper discussion with a healthcare professional.…”