Polypharmacy during pregnancy and associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019
Anuradhaa Subramanian,
Amaya Azcoaga-Lorenzo,
Astha Anand,
Katherine Phillips,
Siang Ing Lee,
Neil Cockburn,
Adeniyi Francis Fagbamigbe,
Christine Damase-Michel,
Christopher Yau,
Colin McCowan,
Dermot O’Reilly,
Gillian Santorelli,
Holly Hope,
Jonathan I. Kennedy,
Kathryn M. Abel,
Kelly-Ann Eastwood,
Louise Locock,
Mairead Black,
Maria Loane,
Ngawai Moss,
Rachel Plachcinski,
Shakila Thangaratinam,
Sinead Brophy,
Utkarsh Agrawal,
Zoe Vowles,
Peter Brocklehurst,
Helen Dolk,
Catherine Nelson-Piercy,
Krishnarajah Nirantharakumar,
on behalf of the MuM-PreDiCT Group
Affiliations
Anuradhaa Subramanian
Institute of Applied Health Research, University of Birmingham
Amaya Azcoaga-Lorenzo
Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews
Astha Anand
Institute of Applied Health Research, University of Birmingham
Katherine Phillips
Institute of Applied Health Research, University of Birmingham
Siang Ing Lee
Institute of Applied Health Research, University of Birmingham
Neil Cockburn
Institute of Applied Health Research, University of Birmingham
Adeniyi Francis Fagbamigbe
Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews
Christine Damase-Michel
Medical and Clinical Pharmacology, School of Medicine, Université Toulouse III
Christopher Yau
Division of Informatics, Imaging and Data Sciences, Faculty of Biology Medicine and Health, The University of Manchester
Colin McCowan
Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews
Dermot O’Reilly
Centre for Public Health, Queen’s University of Belfast
Gillian Santorelli
Bradford Institute for Health Research
Holly Hope
Centre for Women’s Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester
Jonathan I. Kennedy
Data Science, Medical School, Swansea University
Kathryn M. Abel
Centre for Women’s Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester
Kelly-Ann Eastwood
Centre for Public Health, Queen’s University of Belfast
Louise Locock
Health Services Research Unit, School of Medicine, Medical Science and Nutrition, University of Aberdeen
Mairead Black
Aberdeen Centre for Women’s Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen
Maria Loane
Centre for Maternal, Fetal and Infant Research, The Institute of Nursing and Health Research, Ulster University
Ngawai Moss
Patient and Public Representative
Rachel Plachcinski
Patient and Public Representative
Shakila Thangaratinam
WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham
Sinead Brophy
Data Science, Medical School, Swansea University
Utkarsh Agrawal
Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews
Zoe Vowles
Guy’s and St. Thomas’ NHS Foundation Trust
Peter Brocklehurst
Institute of Applied Health Research, University of Birmingham
Helen Dolk
Centre for Maternal, Fetal and Infant Research, The Institute of Nursing and Health Research, Ulster University
Catherine Nelson-Piercy
Guy’s and St. Thomas’ NHS Foundation Trust
Krishnarajah Nirantharakumar
Institute of Applied Health Research, University of Birmingham
Abstract Background The number of medications prescribed during pregnancy has increased over the past few decades. Few studies have described the prevalence of multiple medication use among pregnant women. This study aims to describe the overall prevalence over the last two decades among all pregnant women and those with multimorbidity and to identify risk factors for polypharmacy in pregnancy. Methods A retrospective cohort study was conducted between 2000 and 2019 using the Clinical Practice Research Datalink (CPRD) pregnancy register. Prescription records for 577 medication categories were obtained. Prevalence estimates for polypharmacy (ranging from 2+ to 11+ medications) were presented along with the medications commonly prescribed individually and in pairs during the first trimester and the entire pregnancy period. Logistic regression models were performed to identify risk factors for polypharmacy. Results During the first trimester (812,354 pregnancies), the prevalence of polypharmacy ranged from 24.6% (2+ medications) to 0.1% (11+ medications). During the entire pregnancy period (774,247 pregnancies), the prevalence ranged from 58.7 to 1.4%. Broad-spectrum penicillin (6.6%), compound analgesics (4.5%) and treatment of candidiasis (4.3%) were commonly prescribed. Pairs of medication prescribed to manage different long-term conditions commonly included selective beta 2 agonists or selective serotonin re-uptake inhibitors (SSRIs). Risk factors for being prescribed 2+ medications during the first trimester of pregnancy include being overweight or obese [aOR: 1.16 (1.14–1.18) and 1.55 (1.53–1.57)], belonging to an ethnic minority group [aOR: 2.40 (2.33–2.47), 1.71 (1.65–1.76), 1.41 (1.35–1.47) and 1.39 (1.30–1.49) among women from South Asian, Black, other and mixed ethnicities compared to white women] and smoking or previously smoking [aOR: 1.19 (1.18–1.20) and 1.05 (1.03–1.06)]. Higher and lower age, higher gravidity, increasing number of comorbidities and increasing level of deprivation were also associated with increased odds of polypharmacy. Conclusions The prevalence of polypharmacy during pregnancy has increased over the past two decades and is particularly high in younger and older women; women with high BMI, smokers and ex-smokers; and women with multimorbidity, higher gravidity and higher levels of deprivation. Well-conducted pharmaco-epidemiological research is needed to understand the effects of multiple medication use on the developing foetus.
