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

Abstract

Caroline Tianeze de Castro,1 Lisiane Freitas Leal,2 Dandara de Oliveira Ramos,1 Jerusa da Mota Santana,3 Rosa Cândida Cordeiro,3,4 Maria da Conceição Costa Rivemales,3,4 Edna Maria de Araújo,5 Carlos Alberto Lima da Silva,5 Marcos Pereira,1 Djanilson Barbosa dos Santos3– 5 1Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil; 2Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, Quebec, Canada; 3Center for Health Sciences, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil; 4Postgraduation Program in Health for the Black and Indigenous Population, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil; 5State University of Feira de Santana, Feira de Santana, Bahia, BrazilCorrespondence: Caroline Tianeze de Castro, Institute of Collective Health, Federal University of Bahia, Basílio da Gama Street, no number, Canela Campus, Salvador, Bahia, 40.110-040, Brazil, Email [email protected]: This study aimed to evaluate racial disparities in medication use and associated factors among pregnant women receiving prenatal care at Brazilian Unified Health System primary care health units in the northeast region.Patients and Methods: A total of 1058 pregnant women in the NISAMI Cohort were interviewed between June 2012 and February 2014. Medicines used during pregnancy were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and ANVISA pregnancy risk categories. Prevalence ratios (crude and adjusted) and 95% confidence intervals (CIs) were estimated using Poisson regression with robust error variance. All analyses were stratified by race (Asian, black, brown/mixed, Brazilian indigenous, and white).Results: Approximately 84% of the pregnant women used at least one medication, with a lower proportion among white women. The most reported medications were antianemic preparations (71.08%; 95% CI 68.27– 73.72%), analgesics (21.74%; 95% CI 19.36– 24.32%), and drugs for functional gastrointestinal disorders (18.81%; 95% CI 16.57– 21.28%). Approximately 29% of women took potentially risky medications during pregnancy, with a higher prevalence among Asian and white women. Factors associated with medication use during pregnancy include a greater number of prenatal consultations, higher education levels, health problems, and smoking. In addition, maternal age above 25 years, smoking status, and two or more previous pregnancies were associated with potentially risky medication use during pregnancy.Conclusion: A high prevalence of medication use during pregnancy was found; however, this prevalence was lower among white women. Nonetheless, black and brown women used antianemic preparations less frequently. This finding suggests that race is a factor of inequity in prenatal care, demanding public policies to mitigate it.Keywords: drug utilization, racial groups, pregnancy, pharmacoepidemiology, cohort studies

Keywords

• drug utilization
• racial groups
• pregnancy
• pharmacoepidemiology
• cohort studies.