Prescribed and Non- prescribed Medication Use in Early Pregnancy in a Prospective Cohort of Women Brian J Cleary, Hajeera Butt, Judith Strawbridge, Paul Gallagher, Tom Fahey, Deirdre J Murphy

Introduction Objectives –Determine extent and nature of medication use in early pregnancy –Explore inappropriate prescribing with potential for fetal harm –Explore prescribing for pre-existing medical disorders. No large Irish studies conducted High prevalence of medication use in pregnancy in international studies

Methods Establishment of dataset Medications reported at booking interview Data cleaning and categorisation Women with antenatal booking interview & delivery suite record (n=61252)

Results 4 in 10 women took a medication prior to booking (excluding folic acid) 1 in 5 women took an OTC product Most common medications –Analgesics –Antibacterials –Asthma medications –Iron Preparations –Sex hormones

Results Categorisation of medication exposures according to FDA pregnancy category *Medications with no FDA pregnancy category (excludes folic acid, vitamins and minerals) Category D- evidence of fetal risk, benefits may outweigh harm Category X- evidence of fetal risk, any possible benefit outweighed by risk

Results

Factors associated with use of any medication Age >35y Booking >20/40 Unplanned pregnancy* (OR 1.38, 95% CI 1.33, 1.42) Multiple pregnancy* (OR 1.33, 95% CI 1.17, 1.51) Single marital status* (OR 1.15, 95% CI 1.11, 1.19) Smoking in pregnancy* (OR 1.19, 95% CI 1.14, 1.24) Being a private patient* (OR 1.46, 95% CI 1.41, 1.51) *Odds ratio relative to not having characteristic

Factors associated with use of potentially harmful medication Booking <12/40 Being unemployed Unplanned pregnancy* (OR 1.63, 95% CI 1.47, 1.81) Single marital status* (OR 2.22, 95% CI 2.00, 2.46) Multiple pregnancy* (OR 1.56, 95% CI 1.13, 2.13) Smoking in pregnancy* (OR 3.31, 95% CI 2.98, 3.67) Publicly funded patient* (OR 1.49, 95% CI 1.32, 1.68) *Odds ratio relative to not having characteristic

Chronic Medical Disorders Commonly reported disorders –Asthma 9.3% –Depression9.2% –Hypertension2.3% Paroxetine reported in 15.5% of women treated for depression Atenolol or ACE inhibitors reported by 20.1% of women treated for hypertension

Conclusions Medication use in early pregnancy is common Overall level of prescribing of potentially harmful medications low Some subgroups with suboptimal treatment –Patients with depression treated with paroxetine –Patients with hypertension treated with atenolol / ACE inhibitors Some subgroups of the population more likely to report medications with potential for fetal harm Adequate pre-pregnancy counselling essential to ensure optimal medication use in pregnancy Dataset offers potential for future pregnancy outcome studies

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