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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 Orcid Logo, Amaya Azcoaga-Lorenzo Orcid Logo, Astha Anand Orcid Logo, Katherine Phillips Orcid Logo, Siang Ing Lee Orcid Logo, Neil Cockburn Orcid Logo, Adeniyi Francis Fagbamigbe Orcid Logo, Christine Damase-Michel Orcid Logo, Christopher Yau Orcid Logo, Colin McCowan Orcid Logo, Dermot O’Reilly Orcid Logo, Gillian Santorelli Orcid Logo, Holly Hope Orcid Logo, Jonathan I. Kennedy Orcid Logo, Kathryn M. Abel Orcid Logo, Kelly-Ann Eastwood Orcid Logo, Louise Locock Orcid Logo, Mairead Black Orcid Logo, Maria Loane Orcid Logo, Ngawai Moss Orcid Logo, Rachel Plachcinski Orcid Logo, Shakila Thangaratinam Orcid Logo, Sinead Brophy Orcid Logo, Utkarsh Agrawal Orcid Logo, Zoe Vowles Orcid Logo, Peter Brocklehurst Orcid Logo, Helen Dolk Orcid Logo, Catherine Nelson-Piercy Orcid Logo, Krishnarajah Nirantharakumar Orcid Logo, (on behalf of the MuM-PreDiCT Group)

BMC Medicine, Volume: 21, Issue: 1

Swansea University Author: Sinead Brophy Orcid Logo

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DOI (Published version): 10.1186/s12916-022-02722-5

Abstract

BackgroundThe 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 an...

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Published in: BMC Medicine
ISSN: 1741-7015
Published: Springer Science and Business Media LLC 2023
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2024-06-19T15:52:47.0667175</datestamp><bib-version>v2</bib-version><id>66424</id><entry>2024-05-15</entry><title>Polypharmacy during pregnancy and&#xA0;associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019</title><swanseaauthors><author><sid>84f5661b35a729f55047f9e793d8798b</sid><ORCID>0000-0001-7417-2858</ORCID><firstname>Sinead</firstname><surname>Brophy</surname><name>Sinead Brophy</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2024-05-15</date><deptcode>MEDS</deptcode><abstract>BackgroundThe 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.MethodsA 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.ResultsDuring 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&#x2013;1.18) and 1.55 (1.53&#x2013;1.57)], belonging to an ethnic minority group [aOR: 2.40 (2.33&#x2013;2.47), 1.71 (1.65&#x2013;1.76), 1.41 (1.35&#x2013;1.47) and 1.39 (1.30&#x2013;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&#x2013;1.20) and 1.05 (1.03&#x2013;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.ConclusionsThe 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.</abstract><type>Journal Article</type><journal>BMC Medicine</journal><volume>21</volume><journalNumber>1</journalNumber><paginationStart/><paginationEnd/><publisher>Springer Science and Business Media LLC</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1741-7015</issnElectronic><keywords>Multiple medications, Polypharmacy, Medications, Prescriptions, Pregnancy, Multimorbidity, Multiple longterm conditions</keywords><publishedDay>16</publishedDay><publishedMonth>1</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-01-16</publishedDate><doi>10.1186/s12916-022-02722-5</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>This work was funded by the Strategic Priority Fund &#x201C;Tackling multimorbidity at scale&#x201D; 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. BT was funded by the National Institute for Health Research (NIHR) West Midlands Applied Research Collaboration. AA, KP and SIL were funded as NIHR Academic Clinical Fellows. The views expressed are those of the authors and not necessarily those of the funders, the NIHR or the UK Department of Health and Social Care. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.</funders><projectreference/><lastEdited>2024-06-19T15:52:47.0667175</lastEdited><Created>2024-05-15T08:41:26.7533659</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Anuradhaa</firstname><surname>Subramanian</surname><orcid>0000-0001-8875-7363</orcid><order>1</order></author><author><firstname>Amaya</firstname><surname>Azcoaga-Lorenzo</surname><orcid>0000-0003-3307-878x</orcid><order>2</order></author><author><firstname>Astha</firstname><surname>Anand</surname><orcid>0000-0003-0494-321x</orcid><order>3</order></author><author><firstname>Katherine</firstname><surname>Phillips</surname><orcid>0000-0003-0674-605x</orcid><order>4</order></author><author><firstname>Siang Ing</firstname><surname>Lee</surname><orcid>0000-0002-2332-5452</orcid><order>5</order></author><author><firstname>Neil</firstname><surname>Cockburn</surname><orcid>0000-0001-9284-6991</orcid><order>6</order></author><author><firstname>Adeniyi Francis</firstname><surname>Fagbamigbe</surname><orcid>0000-0001-9184-8258</orcid><order>7</order></author><author><firstname>Christine</firstname><surname>Damase-Michel</surname><orcid>0000-0001-5018-0108</orcid><order>8</order></author><author><firstname>Christopher</firstname><surname>Yau</surname><orcid>0000-0001-7615-8523</orcid><order>9</order></author><author><firstname>Colin</firstname><surname>McCowan</surname><orcid>0000-0002-9466-833x</orcid><order>10</order></author><author><firstname>Dermot</firstname><surname>O&#x2019;Reilly</surname><orcid>0000-0002-9181-0652</orcid><order>11</order></author><author><firstname>Gillian</firstname><surname>Santorelli</surname><orcid>0000-0003-0427-1783</orcid><order>12</order></author><author><firstname>Holly</firstname><surname>Hope</surname><orcid>0000-0002-4834-6719</orcid><order>13</order></author><author><firstname>Jonathan I.</firstname><surname>Kennedy</surname><orcid>0000-0002-1122-6502</orcid><order>14</order></author><author><firstname>Kathryn M.</firstname><surname>Abel</surname><orcid>0000-0003-3538-8896</orcid><order>15</order></author><author><firstname>Kelly-Ann</firstname><surname>Eastwood</surname><orcid>0000-0003-3689-0490</orcid><order>16</order></author><author><firstname>Louise</firstname><surname>Locock</surname><orcid>0000-0002-8109-1930</orcid><order>17</order></author><author><firstname>Mairead</firstname><surname>Black</surname><orcid>0000-0002-6841-8601</orcid><order>18</order></author><author><firstname>Maria</firstname><surname>Loane</surname><orcid>0000-0002-1206-3637</orcid><order>19</order></author><author><firstname>Ngawai</firstname><surname>Moss</surname><orcid>0000-0001-9369-5072</orcid><order>20</order></author><author><firstname>Rachel</firstname><surname>Plachcinski</surname><orcid>0000-0001-9908-0773</orcid><order>21</order></author><author><firstname>Shakila</firstname><surname>Thangaratinam</surname><orcid>0000-0002-4254-460x</orcid><order>22</order></author><author><firstname>Sinead</firstname><surname>Brophy</surname><orcid>0000-0001-7417-2858</orcid><order>23</order></author><author><firstname>Utkarsh</firstname><surname>Agrawal</surname><orcid>0000-0001-5181-6120</orcid><order>24</order></author><author><firstname>Zoe</firstname><surname>Vowles</surname><orcid>0000-0001-6989-2180</orcid><order>25</order></author><author><firstname>Peter</firstname><surname>Brocklehurst</surname><orcid>0000-0002-9950-6751</orcid><order>26</order></author><author><firstname>Helen</firstname><surname>Dolk</surname><orcid>0000-0001-6639-5904</orcid><order>27</order></author><author><firstname>Catherine</firstname><surname>Nelson-Piercy</surname><orcid>0000-0001-9311-1196</orcid><order>28</order></author><author><firstname>Krishnarajah</firstname><surname>Nirantharakumar</surname><orcid>0000-0002-6816-1279</orcid><order>29</order></author><author><firstname>(on behalf of the MuM-PreDiCT</firstname><surname>Group)</surname><order>30</order></author></authors><documents><document><filename>66424__30372__b62b330a8e774fc0bb24560894631253.pdf</filename><originalFilename>66424.pdf</originalFilename><uploaded>2024-05-15T08:44:33.8188307</uploaded><type>Output</type><contentLength>1376818</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>This article is licensed under a Creative Commons Attribution 4.0 International License.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2024-06-19T15:52:47.0667175 v2 66424 2024-05-15 Polypharmacy during pregnancy and associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019 84f5661b35a729f55047f9e793d8798b 0000-0001-7417-2858 Sinead Brophy Sinead Brophy true false 2024-05-15 MEDS BackgroundThe 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.MethodsA 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.ResultsDuring 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.ConclusionsThe 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. Journal Article BMC Medicine 21 1 Springer Science and Business Media LLC 1741-7015 Multiple medications, Polypharmacy, Medications, Prescriptions, Pregnancy, Multimorbidity, Multiple longterm conditions 16 1 2023 2023-01-16 10.1186/s12916-022-02722-5 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee 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. BT was funded by the National Institute for Health Research (NIHR) West Midlands Applied Research Collaboration. AA, KP and SIL were funded as NIHR Academic Clinical Fellows. The views expressed are those of the authors and not necessarily those of the funders, the NIHR or the UK Department of Health and Social Care. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. 2024-06-19T15:52:47.0667175 2024-05-15T08:41:26.7533659 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Anuradhaa Subramanian 0000-0001-8875-7363 1 Amaya Azcoaga-Lorenzo 0000-0003-3307-878x 2 Astha Anand 0000-0003-0494-321x 3 Katherine Phillips 0000-0003-0674-605x 4 Siang Ing Lee 0000-0002-2332-5452 5 Neil Cockburn 0000-0001-9284-6991 6 Adeniyi Francis Fagbamigbe 0000-0001-9184-8258 7 Christine Damase-Michel 0000-0001-5018-0108 8 Christopher Yau 0000-0001-7615-8523 9 Colin McCowan 0000-0002-9466-833x 10 Dermot O’Reilly 0000-0002-9181-0652 11 Gillian Santorelli 0000-0003-0427-1783 12 Holly Hope 0000-0002-4834-6719 13 Jonathan I. Kennedy 0000-0002-1122-6502 14 Kathryn M. Abel 0000-0003-3538-8896 15 Kelly-Ann Eastwood 0000-0003-3689-0490 16 Louise Locock 0000-0002-8109-1930 17 Mairead Black 0000-0002-6841-8601 18 Maria Loane 0000-0002-1206-3637 19 Ngawai Moss 0000-0001-9369-5072 20 Rachel Plachcinski 0000-0001-9908-0773 21 Shakila Thangaratinam 0000-0002-4254-460x 22 Sinead Brophy 0000-0001-7417-2858 23 Utkarsh Agrawal 0000-0001-5181-6120 24 Zoe Vowles 0000-0001-6989-2180 25 Peter Brocklehurst 0000-0002-9950-6751 26 Helen Dolk 0000-0001-6639-5904 27 Catherine Nelson-Piercy 0000-0001-9311-1196 28 Krishnarajah Nirantharakumar 0000-0002-6816-1279 29 (on behalf of the MuM-PreDiCT Group) 30 66424__30372__b62b330a8e774fc0bb24560894631253.pdf 66424.pdf 2024-05-15T08:44:33.8188307 Output 1376818 application/pdf Version of Record true This article is licensed under a Creative Commons Attribution 4.0 International License. true eng https://creativecommons.org/licenses/by/4.0/
title Polypharmacy during pregnancy and associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019
spellingShingle Polypharmacy during pregnancy and associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019
Sinead Brophy
title_short Polypharmacy during pregnancy and associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019
title_full Polypharmacy during pregnancy and associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019
title_fullStr Polypharmacy during pregnancy and associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019
title_full_unstemmed Polypharmacy during pregnancy and associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019
title_sort Polypharmacy during pregnancy and associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019
author_id_str_mv 84f5661b35a729f55047f9e793d8798b
author_id_fullname_str_mv 84f5661b35a729f55047f9e793d8798b_***_Sinead Brophy
author Sinead Brophy
author2 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)
format Journal article
container_title BMC Medicine
container_volume 21
container_issue 1
publishDate 2023
institution Swansea University
issn 1741-7015
doi_str_mv 10.1186/s12916-022-02722-5
publisher Springer Science and Business Media LLC
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description BackgroundThe 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.MethodsA 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.ResultsDuring 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.ConclusionsThe 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.
published_date 2023-01-16T05:20:15Z
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score 11.089572

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