Professor Universidade Federal do Recôncavo da Bahia (UFRB) Feira de Santana, Brazil
Background: Medicine use during pregnancy is a common practice worldwide; however, it may differ by race due to institutional racism, which poses differences in the distribution of services and opportunities to different races generating inequalities and inequities.
Objectives: To evaluate racial disparities in medicine use prevalence and the factors associated with medicine and potentially risky medicine use among women attending prenatal care at the Brazilian Unified Health System primary care units in the Northeast region.
Methods: 1,058 pregnant women within the NISAMI Cohort were interviewed between June 2012 and February 2014. Medicines used during pregnancy were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and ANVISA’s Pregnancy Risk Categories. All the analyses were stratified by race: black (black and brown/mixed) and non-black (Asian, white, and Brazilian indigenous). Prevalence Ratio (PR) (crude and adjusted) and 95% confidence intervals (95%CI) were estimated by Poisson regression with robust error variance.
Results: Approximately 84% of the women used at least one medicine during pregnancy, with a lower proportion among black (83.8%) compared to non-black pregnant women (87.0%). Overall, the most reported medicines were antianemic preparations (71.1%), analgesics (21.7%), and drugs for functional gastrointestinal (GI) disorders (18.8%). Antianemic preparations, analgesics and drugs for functional gastrointestinal disorders (GI) use was less prevalent among black women than non-black. More than 11 years of education (PR 1.11; 95%CI 1.01-1.22), access to more than three prenatal consultations (PR 1.23; 95%CI 1.18-1.29), and health problems (PR 1.10; 95%CI 1.04-1.16) remained associated with medication use among black pregnant women, while access to more than three prenatal consultations (PR 1.26; 95% CI 1.13-1.39) among non-black. A higher prevalence of potentially risky medication use was found among black pregnant women aged between 25 and 29 (PR 1.61; 95% CI 1.21-2.15), 30 to 35 (PR 1.74; 95% CI 1.30-2.33), and 36 years or more (PR 1.81; 95% CI 1.18-2.79), and that smoked during pregnancy (PR 1.734; 95% CI 1.10-2.71). Among non-black women, only those with at least two previous pregnancies (PR 1.77; 95% CI 1.08-2.91) had a higher prevalence of potentially risky medication use.
Conclusions: A high prevalence of medicine use during pregnancy was found, which was lower among black women, including for medicines indicated during pregnancy as antianemic preparations. Therefore, these findings suggest that race is a factor of inequity in prenatal care, demanding public policies to mitigate them.
