Background: While medication use during pregnancy has increased over the last few decades in the US, trends are not uniform. Identifying the currently most common prescription medications can inform research priorities.
Objectives: To examine trends in medication use during pregnancy in the last decade.
Methods: We identified population-based cohorts of publicly (Medicaid 2011-2017) and privately (MarketScan 2011-2019) insured pregnant women from two healthcare utilization databases. Medication use was based on filled prescriptions and was assessed between 90 days prior to the date of last menstrual period (LMP) through delivery, as well as during specific trimesters. The most common medications utilized in each trimester are reported. Additionally, medications and classes of particular interest were selected a priori to examine their yearly utilization (analgesics, antiemetics, antidiabetics, psychotropics, hormones, and known/suspected teratogens).
Results: Among over 3 million pregnancies, the top medications used from LMP to delivery were analgesics, antibiotics, and anti-emetic agents. For example, utilization was 13.5% for amoxicillin in MarketScan and 22.2% for nitrofurantoin in Medicaid at any time during pregnancy. Among analgesics, a decrease in any opioid dispensing was observed: 15.9% to 7.7% in MarketScan 2011-2019 and 21.2% to 10.5% in Medicaid 2011-2017. Among antiemetics, ondansetron use initially increased from 19.6% in 2011 to 22.8% in 2013 and then decreased to 15.6% in 2020 in MarketScan; use increased from 17.8% in 2011 to 26.5% in 2014 and then decreased to 18.6% in 2017 in Medicaid. Over the study period, doxylamine/pyridoxine utilization increased from < 1.0% in both databases to 2.5% and 6.2% in MarketScan and Medicaid, respectively. Among antidiabetics, metformin utilization approximately doubled to reach 4.3% in MarketScan and 3.0% in Medicaid. Use of levothyroxine increased from 5.5% to 7.6% in MarketScan and from 1.8% to 2.8% in Medicaid. Known/suspected teratogens utilization during the 1st trimester was low ( < 0.1%) across all years. Trends in other medications were relatively stable during the study period.
Conclusions: Amongst others, the use of cardiometabolic medications has increased and the use of antiemetic medications continues to be common. Several of these medications have insufficient data available to characterize their safety profile, highlighting the need to generate evidence to address gaps in information about fetal risk for some commonly used medications.
