Changes in prescription medication use by pregnant women after 2010 in US

Key takeaways:

• The most prescribed medications were ondansetron, amoxicillin, azithromycin, nitrofurantoin and acetaminophen.
• Since 2010, opioid use decreased, and diabetes and psychotropic medication use increased.

Opioid and teratogenic medication prescriptions decreased and prescriptions for medications for diabetes and mental health conditions increased among pregnant women after 2010 in the U.S., researchers reported.

“While there are several studies on the utilization and safety of medications in the past decades, fewer studies exist for the post 2010 period,” Omar Mansour, MHS, from the department of epidemiology at Harvard T.H. Chan School of Public Health and the division of pharmacoepidemiology and pharmacoeconomics in the department of medicine at Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote. “As such, with increasing prevalence of chronic diseases that may require initiation and continuation of pharmacologic treatment during pregnancy for optimal maternal health, additional research is needed to fill the remaining gaps in knowledge on fetal effects.”

Mansour and colleagues identified population-based cohorts of 1,754,125 commercially insured pregnancies from the MarketScan Commercial Claims and Encounters database (2011-2020) and 1,475,321 publicly insured pregnancies from the Medicaid Analytic eXtract/Transformed Medicaid Statistical Information System Analytic Files (MAX/TAF; 2011-2017). All pregnancies ended with live births. Researchers evaluated medication use based on filled prescriptions between the date of one’s last menstrual period through delivery. In addition, researchers included a cross-sectional representative pregnancy sample with data on prescription medication use during the preceding month collected from the National Health and Nutrition Examination Survey (n = 415).

Results were published in the American Journal of Obstetrics and Gynecology.

The most dispensed prescription medications during any time throughout pregnancy were analgesics, antibiotics and antiemetics. The most prescribed medications in MarketScan data were ondansetron (16.8%), amoxicillin (13.5%) and azithromycin (12.4%), and the most prescribed medications in MAX/TAF data were nitrofurantoin (22.2%), acetaminophen (21.3%) and ondansetron (19.5%). The most prescribed medications in NHANES were levothyroxine (5%), sertraline (2.9%) and insulin (2.9%).

During the first trimester of pregnancy, the most dispensed prescription teratogens were antithyroid medications. In MarketScan and MAX/TAF data, respectively, researchers observed increased use of diabetes (3.8% in 2011 to 4.8% in 2020 and 2.6% in 2011 to 3.3% in 2017) and psychotropic medication (16.8% in 2011 to 20.9% in 2020 and 17.4% in 2011 to 19.6% in 2017) in the past decade. However, opioid use decreased from 20.6% in 2011 to 16.7% in 2020 in MarketScan and 29.9% in 2011 to 23.6% in 2017 in MAX/TAF while antibiotic and antiemetics continue to be commonly prescribed, according to the researchers.

In addition, researchers noted that insufficient evidence was available for 25% of prescribed medications to characterize their safety profile in pregnant women.

“Future research efforts should focus on the identified anti-infectives as they are medications with high utilization but with limited level of evidence on safety for use during pregnancy,” the researchers wrote.