Prevalence of polypharmacy in pregnancy: a systematic review

Astha Anand; Katherine Phillips; Anuradhaa Subramanian; Siang Ing Lee; Zhaonan Wang; Rebecca McCowan; Utkarsh Agrawal; Adeniyi Frances Fagbamigbe; Catherine Nelson-Piercy; Peter Brocklehurst; Christine Damase-Michel; Maria Loane; Krishnarajah Nirantharakumar; Amaya Azcoaga-Lorenzo

doi:10.1136/bmjopen-2022-067585

Prevalence of polypharmacy in pregnancy: a systematic review

Astha Anand
, Katherine Phillips
, Anuradhaa Subramanian
, Siang Ing Lee
, Zhaonan Wang
, Rebecca McCowan
, Utkarsh Agrawal
, Adeniyi Frances Fagbamigbe
, Catherine Nelson-Piercy
, Peter Brocklehurst
, Christine Damase-Michel
, Maria Loane
, Krishnarajah Nirantharakumar^* (Corresponding Author)
, Amaya Azcoaga-Lorenzo

^*Corresponding author for this work

Applied Health Sciences

Research output: Contribution to journal › Article › peer-review

10 Citations (Scopus)

1 Downloads (Pure)

Abstract

Objectives: The use of medications among pregnant women has been rising over the past few decades but the reporting of polypharmacy has been sporadic. The objective of this review is to identify literature reporting the prevalence of polypharmacy among pregnant women, the prevalence of multimorbidity in women taking multiple medications in pregnancy and associated effects on maternal and offspring outcomes.

Design: MEDLINE and Embase were searched from their inception to 14 September 2021 for interventional trials, observational studies and systematic reviews reporting on the prevalence of polypharmacy or the use of multiple medications in pregnancy were included. Data on prevalence of polypharmacy, prevalence of multimorbidity, combinations of medications and pregnancy and offspring outcomes were extracted. A descriptive analysis was performed.

Results: Fourteen studies met the review criteria. The prevalence of women being prescribed two or more medications during pregnancy ranged from 4.9% (4.3%-5.5%) to 62.4% (61.3%-63.5%), with a median of 22.5%. For the first trimester, prevalence ranged from 4.9% (4.7%-5.14%) to 33.7% (32.2%-35.1%). No study reported on the prevalence of multimorbidity, or associated pregnancy outcomes in women exposed to polypharmacy.

Conclusion: There is a significant burden of polypharmacy among pregnant women. There is a need for evidence on the combinations of medications prescribed in pregnancy, how this specifically affects women with multiple long-term conditions and the associated benefits and harms.

Tweetable abstract: Our systematic review shows significant burden of polypharmacy in pregnancy but outcomes for women and offspring are unknown.

Original language	English
Article number	e067585
Number of pages	11
Journal	BMJ Open
Volume	13
Issue number	3
Early online date	6 Mar 2023
DOIs	https://doi.org/10.1136/bmjopen-2022-067585
Publication status	Published - 6 Mar 2023

Bibliographical note

Funding Information:
This work was funded by the Strategic Priority Fund 'Tackling multimorbidity at scale' programme (grant number MR/W014432/1) delivered by the Medical Research Council and the National Institute for Health Research in partnership with the Economic and Social Research Council and in collaboration with the Engineering and Physical Sciences Research Council.

Data Availability Statement

No data are available.

Funding

This work was funded by the Strategic Priority Fund 'Tackling multimorbidity at scale' programme (grant number MR/W014432/1) delivered by the Medical Research Council and the National Institute for Health Research in partnership with the Economic and Social Research Council and in collaboration with the Engineering and Physical Sciences Research Council.

Keywords

EPIDEMIOLOGY
Maternal medicine
OBSTETRICS

Access to Document

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Cite this

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title = "Prevalence of polypharmacy in pregnancy: a systematic review",

abstract = "Objectives: The use of medications among pregnant women has been rising over the past few decades but the reporting of polypharmacy has been sporadic. The objective of this review is to identify literature reporting the prevalence of polypharmacy among pregnant women, the prevalence of multimorbidity in women taking multiple medications in pregnancy and associated effects on maternal and offspring outcomes. Design: MEDLINE and Embase were searched from their inception to 14 September 2021 for interventional trials, observational studies and systematic reviews reporting on the prevalence of polypharmacy or the use of multiple medications in pregnancy were included. Data on prevalence of polypharmacy, prevalence of multimorbidity, combinations of medications and pregnancy and offspring outcomes were extracted. A descriptive analysis was performed. Results: Fourteen studies met the review criteria. The prevalence of women being prescribed two or more medications during pregnancy ranged from 4.9\% (4.3\%-5.5\%) to 62.4\% (61.3\%-63.5\%), with a median of 22.5\%. For the first trimester, prevalence ranged from 4.9\% (4.7\%-5.14\%) to 33.7\% (32.2\%-35.1\%). No study reported on the prevalence of multimorbidity, or associated pregnancy outcomes in women exposed to polypharmacy. Conclusion: There is a significant burden of polypharmacy among pregnant women. There is a need for evidence on the combinations of medications prescribed in pregnancy, how this specifically affects women with multiple long-term conditions and the associated benefits and harms. Tweetable abstract: Our systematic review shows significant burden of polypharmacy in pregnancy but outcomes for women and offspring are unknown.",

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author = "Astha Anand and Katherine Phillips and Anuradhaa Subramanian and Lee, \{Siang Ing\} and Zhaonan Wang and Rebecca McCowan and Utkarsh Agrawal and Fagbamigbe, \{Adeniyi Frances\} and Catherine Nelson-Piercy and Peter Brocklehurst and Christine Damase-Michel and Maria Loane and Krishnarajah Nirantharakumar and Amaya Azcoaga-Lorenzo",

note = "Funding Information: This work was funded by the Strategic Priority Fund 'Tackling multimorbidity at scale' programme (grant number MR/W014432/1) delivered by the Medical Research Council and the National Institute for Health Research in partnership with the Economic and Social Research Council and in collaboration with the Engineering and Physical Sciences Research Council. ",

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doi = "10.1136/bmjopen-2022-067585",

language = "English",

volume = "13",

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AU - Phillips, Katherine

AU - Subramanian, Anuradhaa

AU - Lee, Siang Ing

AU - Wang, Zhaonan

AU - McCowan, Rebecca

AU - Agrawal, Utkarsh

AU - Fagbamigbe, Adeniyi Frances

AU - Nelson-Piercy, Catherine

AU - Brocklehurst, Peter

AU - Damase-Michel, Christine

AU - Loane, Maria

AU - Nirantharakumar, Krishnarajah

AU - Azcoaga-Lorenzo, Amaya

N1 - Funding Information: This work was funded by the Strategic Priority Fund 'Tackling multimorbidity at scale' programme (grant number MR/W014432/1) delivered by the Medical Research Council and the National Institute for Health Research in partnership with the Economic and Social Research Council and in collaboration with the Engineering and Physical Sciences Research Council.

PY - 2023/3/6

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N2 - Objectives: The use of medications among pregnant women has been rising over the past few decades but the reporting of polypharmacy has been sporadic. The objective of this review is to identify literature reporting the prevalence of polypharmacy among pregnant women, the prevalence of multimorbidity in women taking multiple medications in pregnancy and associated effects on maternal and offspring outcomes. Design: MEDLINE and Embase were searched from their inception to 14 September 2021 for interventional trials, observational studies and systematic reviews reporting on the prevalence of polypharmacy or the use of multiple medications in pregnancy were included. Data on prevalence of polypharmacy, prevalence of multimorbidity, combinations of medications and pregnancy and offspring outcomes were extracted. A descriptive analysis was performed. Results: Fourteen studies met the review criteria. The prevalence of women being prescribed two or more medications during pregnancy ranged from 4.9% (4.3%-5.5%) to 62.4% (61.3%-63.5%), with a median of 22.5%. For the first trimester, prevalence ranged from 4.9% (4.7%-5.14%) to 33.7% (32.2%-35.1%). No study reported on the prevalence of multimorbidity, or associated pregnancy outcomes in women exposed to polypharmacy. Conclusion: There is a significant burden of polypharmacy among pregnant women. There is a need for evidence on the combinations of medications prescribed in pregnancy, how this specifically affects women with multiple long-term conditions and the associated benefits and harms. Tweetable abstract: Our systematic review shows significant burden of polypharmacy in pregnancy but outcomes for women and offspring are unknown.

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KW - Maternal medicine

KW - OBSTETRICS

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DO - 10.1136/bmjopen-2022-067585

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AN - SCOPUS:85149897587

SN - 2044-6055

VL - 13

JO - BMJ Open

JF - BMJ Open

IS - 3

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ER -

Prevalence of polypharmacy in pregnancy: a systematic review

Abstract

Bibliographical note

Data Availability Statement

Funding

Keywords

Access to Document

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