Use of stimulants, over‐the‐counter and prescription drugs among Danish pregnant women

Volqvartz, Tabia; Vestergaard, Anna Louise; Aagaard, Sissel Kramer; Andreasen, Mette Findal; Lesnikova, Iana; Uldbjerg, Niels; Bor, Pınar

doi:10.1111/bcpt.13396

Cited by 8 publications

(12 citation statements)

References 27 publications

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“…The wide range of reported prevalence estimates also may reflect differences in practices and healthcare systems. 19 Like other studies, 3,9,12,20 acetaminophen was the most commonly used prenatal OTC medication-72.2% of women in our study-followed aspirin and ibuprofen.…”

Section: Discussionsupporting

confidence: 74%

The use, perceptions and knowledge of safety of over-the-counter medications during pregnancy in a Canadian population

Casey,

Velez,

Gaudet

et al. 2023

Womens Health (Lond Engl)

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Background: The prevalence of prenatal over-the-counter medication use in Canadian women is unknown. Methods: A cross-sectional study of prenatal over-the-counter medication use and safety knowledge was conducted among pregnant and post-partum women attending an academic hospital obstetrics clinic. Results: Seventy-two women participated; 90.3% were Caucasian, 69.4% had a college/university degree, and 61.1% lived in an urban area. Of the 72 women, 87.5% used over-the-counter medications prenatally, first (55.6%), second (65.3%), and third (47.2%) trimesters, with prenatal acetaminophen use most common (72.2%). Women who used over-the-counter medications 1–0onths before conception were more likely to use over-the-counter medications during pregnancy, and 18% of women initiated over-the-counter medications in pregnancy. Women self-reported a medium level of over-the-counter medication safety knowledge (73.6%) and responded that not all over-the-counter medications are safe during pregnancy (95.8%). Conclusion: Despite limited safety profiles of some over-the-counter medications, pre-conception and prenatal over-the-counter medication use was high. Further research on the risk of over-the-counter medications and combinations in pregnancy is needed to help women to make safe choices during pregnancy.

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Section: Discussionsupporting

confidence: 74%

The use, perceptions and knowledge of safety of over-the-counter medications during pregnancy in a Canadian population

Casey,

Velez,

Gaudet

et al. 2023

Womens Health (Lond Engl)

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“…However, the self-reported prevalence of medication intake was limited among the women in this study as only reported by two women with normal weight and two women with obesity (equal to 5.3% of all the included women). A similar prevalence of exposure was found in blood samples from another cohort of first trimester pregnant Danish women, where traces of prescription drugs and over-the-counter medication were found in 5.3% and 8.9% of the women, respectively 40 , supporting that the self-reports reflect the actual exposure pattern. Overall, it is a strength of the present study, that the amount of pharmacological exposures are indeed very limited, hereby providing stronger data on the impact of maternal body composition on ABCB1 and ABCG2 expression.…”

Section: Discussionsupporting

confidence: 72%

ABCB1 expression is increased in human first trimester placenta from pregnant women classified as overweight or obese

Justesen

Bilde

Olesen

et al. 2023

Sci Rep

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Obesity has become a global health challenge also affecting reproductive health. In pregnant women, obesity increases the risk of complications such as preterm birth, macrosomia, gestational diabetes, and preeclampsia. Moreover, obesity is associated with long-term adverse effects for the offspring, including increased risk of cardiovascular and metabolic diseases and neurodevelopmental difficulties. The underlying mechanisms are far from understood, but placental function is essential for pregnancy outcome. Transporter proteins P-glycoprotein (P-gp) and Breast Cancer Resistance Protein (BCRP) are important for trans-placental transport of endogenous substances like lipids and cortisol, a key hormone in tissue maturation. They also hold a protective function protecting the fetus from xenobiotics (e.g. pharmaceuticals). Animal studies suggest that maternal nutritional status can affect expression of placental transporters, but little is known about the effect on the human placenta, especially in early pregnancy. Here, we investigated if overweight and obesity in pregnant women altered mRNA expression of ABCB1 encoding P-gp or ABCG2 encoding BCRP in first trimester human placenta. With informed consent, 75 first trimester placental samples were obtained from women voluntarily seeking surgical abortion (< gestational week 12) (approval no.: 20060063). Villous samples (average gestational age 9.35 weeks) were used for qPCR analysis. For a subset (n = 38), additional villi were snap-frozen for protein analysis. Maternal BMI was defined at the time of termination of pregnancy. Compared to women with BMI 18.5–24.9 kg/m2 (n = 34), ABCB1 mRNA expression was significantly increased in placenta samples from women classified as overweight (BMI 25–29.9 kg/m2, n = 18) (p = 0.040) and women classified as obese (BMI ≥ 30 kg/m2, n = 23) (p = 0.003). Albeit P-gp expression did not show statistically significant difference between groups, the effect of increasing BMI was the same in male and female pregnancies. To investigate if the P-gp increase was compensated, we determined the expression of ABCG2 which was unaffected by maternal obesity (p = 0.291). Maternal BMI affects ABCB1 but not ABCG2 mRNA expression in first trimester human placenta. Further studies of early placental function are needed to understand how the expression of placental transport proteins is regulated by maternal factors such as nutritional status and determine the potential consequences for placental–fetal interaction.

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“…In studies on self‐reported usages of OTC medications, up to more than half of first‐trimester pregnant women use acetaminophen 32,33 . However, cross‐sectional studies reveal only acetaminophen in 7.1–8.9% of blood samples of first‐trimester pregnant women, indicating that the self‐reported use was only occasionally 34,35 . OTC medication effects should be included when considering foetal harmful effects of polypharmacy in early pregnancy 36–38 …”

Section: Discussionmentioning

confidence: 99%

“…32,33 However, cross-sectional studies reveal only acetaminophen in 7.1-8.9% of blood samples of firsttrimester pregnant women, indicating that the selfreported use was only occasionally. 34,35 OTC medication effects should be included when considering foetal harmful effects of polypharmacy in early pregnancy. [36][37][38] All studies try to take some confounding factors into account by matching, exclusion or adjusting; however, only few studies 24,25 adjust for the most common factors for congenital malformations like maternal age, 39 smoking 40 or BMI.…”

Section: Summary and Interpretation Of Evidence Levelmentioning

confidence: 99%

Polypharmacy in polymorbid pregnancies and the risk of congenital malformations—A systematic review

Thunbo

Vendelbo

Volqvartz

et al. 2021

Basic Clin Pharma Tox

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With an increased prevalence of concurrent morbidities during pregnancy, polypharmacy has become increasingly common in pregnant women. The risks associated with polypharmacy may exceed those of individual medication because of drug–drug interactions. This systematic review aims to evaluate the risk of congenital malformations in polymorbid pregnancies exposed to first‐trimester polypharmacy. PubMed, Embase and Scopus were searched to identify original human studies with first‐ trimester polypharmacy due to polymorbidity as the exposure and congenital malformations as the outcome. After screening of 4034 identified records, seven studies fulfilled the inclusion criteria. Four of the seven studies reported an increased risk of congenital malformations compared with unexposed or monotherapy, odds ratios ranging from 1.1 to >10.0. Particularly, short‐term anti‐infective treatment combined with other drugs and P‐glycoprotein substrates were associated with increased malformation risks. In conclusion, knowledge is limited on risks associated with first‐trimester polypharmacy due to polymorbidity with the underlying evidence of low quantity and quality. Therefore, an increased focus on pharmacovigilance to enable safe drug use in early pregnancy is needed. Large‐scale register‐based studies and better knowledge of placental biology are needed to support the clinical management of polymorbid pregnancies that require polypharmacy.

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Use of stimulants, over‐the‐counter and prescription drugs among Danish pregnant women

Cited by 8 publications

References 27 publications

The use, perceptions and knowledge of safety of over-the-counter medications during pregnancy in a Canadian population

The use, perceptions and knowledge of safety of over-the-counter medications during pregnancy in a Canadian population

ABCB1 expression is increased in human first trimester placenta from pregnant women classified as overweight or obese

Polypharmacy in polymorbid pregnancies and the risk of congenital malformations—A systematic review

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