Associate Professor University of Southern California Los Angeles, United States
Background: Despite recent changes in the labeling of safety risks for prescription medications during pregnancy, recent information on the use of prescription medications, including those potentially harmful or teratogenic, among women of reproductive age in the U.S. is not known.
Objectives: To examine trends in the use and concurrent use of prescription medications, overall and by pregnancy risk) among pregnant and non-pregnant women ages 20-44 years in the US.
Methods: We conducted a descriptive analyses of the most recent five cycles of NHANES (2009-10, 2011-2012, 2013-2014, 2015-2016 and 2017-2020) to estimate the prevalence of prescription medication use in the past 30 days among women aged 20-44 years by current pregnancy status (pregnant or non-pregnant) in the U.S. We used Micromedex to identify medications potentially harmful during pregnancy based on fetal risk. We analyzed the use and concurrent use of prescription medications overall and potentially harmful medications among pregnant and non-pregnant women during the study period.
Results: Among pregnant women ages 20-44, the use of any prescription medication increased from 27.4% to 36.1% from 2009-2010 to 2017-2020 (p < 0.05) and did not change in non-pregnant women during this time period (from 47.1% to 45.7%; p=0.42). The use of potentially harmful medications increased significantly in pregnant women (from 20.7% to 30.8%;p < 0.05) but did not change in non-pregnant women (38.4% to 37.9%;p=0.53). The most commonly used medications also varied among pregnant and non-pregnant women during this period. During 2015-2020, pregnant women were more likely than non-pregnant women to use anti-emetics (e.g., ondansetron) and antidiabetic agents (e.g., metformin, glyburide). In contrast, NSAIDs, ACE inhibitors, and benzodiazepines - which are classified as potentially harmful during pregnancy - were only used among non-pregnant women in 2015-2020. Antidepressants, particularly SSRIs (e.g. sertraline) which are potentially harmful, are increasingly being used in pregnant women (from 1.4% to 6.3%;p < 0.05). Nearly 10% of non-pregnant women used antidepressants throughout the study period.
Conclusions: Pregnant women in the U.S. are increasingly using prescription medications with nearly 1 in 3 using medications associated with the potential risk for fetal harm. While several commonly used medications, including NSAIDs, ACE inhibitors, and benzodiazepines, associated with potential harm were not used in pregnant women in recent years, antidepressants were increasingly used. These findings suggest that efforts to monitor the mental health and safety of antidepressants among pregnant women in the U.S. should be prioritized
