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. 2023 Mar 6;13(3):e067585.
doi: 10.1136/bmjopen-2022-067585.

Prevalence of polypharmacy in pregnancy: a systematic review

Astha Anand  1 , Katherine Phillips  1 , Anuradhaa Subramanian  1 , Siang Ing Lee  1 , Zhaonan Wang  1 , Rebecca McCowan  2 , Utkarsh Agrawal  3 , Adeniyi Frances Fagbamigbe  3   4   5 , Catherine Nelson-Piercy  6 , Peter Brocklehurst  1 , Christine Damase-Michel  7 , Maria Loane  8 , Krishnarajah Nirantharakumar  9 , Amaya Azcoaga-Lorenzo  3 ; MuM-PreDiCT Group
Affiliations

Prevalence of polypharmacy in pregnancy: a systematic review

Astha Anand et al. BMJ Open. .

Abstract

Objectives: The use of medications among pregnant women has been rising over the past few decades but the reporting of polypharmacy has been sporadic. The objective of this review is to identify literature reporting the prevalence of polypharmacy among pregnant women, the prevalence of multimorbidity in women taking multiple medications in pregnancy and associated effects on maternal and offspring outcomes.

Design: MEDLINE and Embase were searched from their inception to 14 September 2021 for interventional trials, observational studies and systematic reviews reporting on the prevalence of polypharmacy or the use of multiple medications in pregnancy were included.Data on prevalence of polypharmacy, prevalence of multimorbidity, combinations of medications and pregnancy and offspring outcomes were extracted. A descriptive analysis was performed.

Results: Fourteen studies met the review criteria. The prevalence of women being prescribed two or more medications during pregnancy ranged from 4.9% (4.3%-5.5%) to 62.4% (61.3%-63.5%), with a median of 22.5%. For the first trimester, prevalence ranged from 4.9% (4.7%-5.14%) to 33.7% (32.2%-35.1%). No study reported on the prevalence of multimorbidity, or associated pregnancy outcomes in women exposed to polypharmacy.

Conclusion: There is a significant burden of polypharmacy among pregnant women. There is a need for evidence on the combinations of medications prescribed in pregnancy, how this specifically affects women with multiple long-term conditions and the associated benefits and harms.

Tweetable abstract: Our systematic review shows significant burden of polypharmacy in pregnancy but outcomes for women and offspring are unknown.

Prospero registration number: CRD42021223966.

Keywords: EPIDEMIOLOGY; Maternal medicine; OBSTETRICS.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Adapted from: Page et al. For more information, visit: http://www.prisma-statement-org/.
Figure 2
Figure 2
Forest plot showing prevalence of polypharmacy, subdivided by the definition of polypharmacy (number of medications taken).
Figure 3
Figure 3
Forest plot showing prevalence of polypharmacy (as defined by the study), for studies which covered all trimesters of the pregnancy and the first trimester.
Figure 4
Figure 4
Forest plot showing prevalence of polypharmacy, subdivided by inclusion or exclusion of over-the-counter medications.
See this image and copyright information in PMC

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