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Current Pharmaceutical Design


ISSN (Print): 1381-6128
ISSN (Online): 1873-4286

Review Article

Women’s Beliefs About Medicines and Adherence to Pharmacotherapy in Pregnancy: Opportunities for Community Pharmacists

Author(s): Michael Ceulemans*, Angela Lupattelli, Hedvig Nordeng, Marina Odalovic, Michael Twigg and Veerle Foulon

Volume 25 , Issue 5 , 2019

Page: [469 - 482] Pages: 14

DOI: 10.2174/1381612825666190321110420

Price: $65


Background: During pregnancy, women might weigh the benefits of treatment against potential risks to the unborn child. However, non-adherence to necessary treatment can adversely affect both mother and child. To optimize pregnant women’s beliefs and medication adherence, community pharmacists are ideally positioned to play an important role in primary care.

Objective: This narrative review aimed to summarize the evidence on 1) pregnant women’s beliefs, 2) medication adherence in pregnancy and 3) community pharmacists’ counselling during pregnancy.

Methods: Three search strategies were used in Medline and Embase to find original studies evaluating women’s beliefs, medication adherence and community pharmacists’ counselling during pregnancy. All original descriptive and analytic epidemiological studies performed in Europe, North America and Australia, written in English and published from 2000 onwards were included.

Results: We included 14 studies reporting on women’s beliefs, 11 studies on medication adherence and 9 on community pharmacists’ counselling during pregnancy. Women are more reluctant to use medicines during pregnancy and tend to overestimate the teratogenic risk of medicines. The risk perception varies with the type of medicine, level of health literacy, education level and occupation. Furthermore, low medication adherence during pregnancy is common. Finally, limited evidence showed that the current community pharmacists’ counselling is insufficient. Barriers hindering pharmacists are insufficient knowledge and limited access to reliable information.

Conclusion: Concerns about medication use and non-adherence are widespread among pregnant women. Community pharmacists’ counselling during pregnancy is insufficient. Further education, training and research are required to support community pharmacists in fulfilling all the opportunities they have when counselling pregnant women.

Keywords: Pregnancy, medicines, beliefs about medicines, risk perception, medication adherence, community pharmacist, counselling.

Daw JR, Hanley GE, Greyson DL, Morgan SG. Prescription drug use during pregnancy in developed countries: A systematic review. Pharmacoepidemiol Drug Saf 2011; 20(9): 895-902.
Mitchell AA, Gilboa SM, Werler MM, Kelley KE, Louik C, Hernández-Díaz S. National Birth Defects Prevention Study. Medication use during pregnancy, with particular focus on prescription drugs: 1976-2008. Am J Obstet Gynecol 2011; 205(1): 51.e1-8.
Palmsten K, Hernández-Díaz S, Chambers CD, et al. The Most Commonly Dispensed Prescription Medications Among Pregnant Women Enrolled in the U.S. Medicaid Program. Obstet Gynecol 2015; 126(3): 465-73.
Lupattelli A, Spigset O, Twigg MJ, et al. Medication use in pregnancy: A cross-sectional, multinational web-based study. BMJ Open 2014; 4(2): e004365.
Werler MM, Mitchell AA, Hernandez-Diaz S, Honein MA. Use of over-the-counter medications during pregnancy. Am J Obstet Gynecol 2005; 193(3 Pt 1): 771-7.
Nordeng H, Ystrøm E, Einarson A. Perception of risk regarding the use of medications and other exposures during pregnancy. Eur J Clin Pharmacol 2010; 66(2): 207-14.
Lenz W, Knapp K. Thalidomide embryopathy. Arch Environ Health 1962; 5: 100-5.
Lammer EJ, Chen DT, Hoar RM, et al. Retinoic acid embryopathy. N Engl J Med 1985; 313(14): 837-41.
Weston J, Bromley R, Jackson CF, et al. Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child. Cochrane Database Syst Rev 2016; 11: CD010224.
Hämeen-Anttila K, Jyrkkä J, Enlund H, Nordeng H, Lupattelli A, Kokki E. Medicines information needs during pregnancy: A multinational comparison. BMJ Open 2013; 3(4): e002594.
Peters SL, Lind JN, Humphrey JR, et al. Safe lists for medications in pregnancy: inadequate evidence base and inconsistent guidance from Web-based information, 2011. Pharmacoepidemiol Drug Saf 2013; 22(3): 324-8.
De Santis M, De Luca C, Quattrocchi T, et al. Use of the Internet by women seeking information about potentially teratogenic agents. Eur J Obstet Gynecol Reprod Biol 2010; 151(2): 154-7.
Hämeen-Anttila K, Nordeng H, Kokki E, et al. Multiple information sources and consequences of conflicting information about medicine use during pregnancy: A multinational Internet-based survey. J Med Internet Res 2014; 16(2): e60.
WHO WHO recommendations on antenatal care for a positive pregnancy experience 2016.
Adam MM. Maternal morbidity.In: Adam MM, EdsPerinatal epidemiology for public health practice. 2009; pp. 49-101.
Taitel M, Jiang J, Rudkin K, Ewing S, Duncan I. The impact of pharmacist face-to-face counseling to improve medication adherence among patients initiating statin therapy. Patient Prefer Adherence 2012; 6: 323-9.
Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: A randomized controlled trial. JAMA 2006; 296(21): 2563-71.
Mehuys E, Van Bortel L, De Bolle L, et al. Effectiveness of pharmacist intervention for asthma control improvement. Eur Respir J 2008; 31(4): 790-9.
Mehuys E, Van Bortel L, De Bolle L, et al. Effectiveness of a community pharmacist intervention in diabetes care: A randomized controlled trial. J Clin Pharm Ther 2011; 36(5): 602-13.
Tommelein E, Mehuys E, Van Hees T, et al. Effectiveness of pharmaceutical care for patients with chronic obstructive pulmonary disease (PHARMACOP): A randomized controlled trial. Br J Clin Pharmacol 2014; 77(5): 756-66.
Viktil KK, Blix HS. The impact of clinical pharmacists on drug-related problems and clinical outcomes. Basic Clin Pharmacol Toxicol 2008; 102(3): 275-80.
Bergkvist Christensen A, Holmbjer L, Midlöv P, et al. The process of identifying, solving and preventing drug related problems in the LIMM-study. Int J Clin Pharm 2011; 33(6): 1010-8.
Smedberg J, Bråthen M, Waka MS, Jacobsen AF, Gjerdalen G, Nordeng H. Medication use and drug-related problems among women at maternity wards-a cross-sectional study from two Norwegian hospitals. Eur J Clin Pharmacol 2016; 72(7): 849-57.
Thompson R, Whennan L, Liang J, Alderman C, Grzeskowiak LE. Investigating the Frequency and Nature of Medication-Related Problems in the Women’s Health Unit of an Australian Tertiary Teaching Hospital. Ann Pharmacother 2015; 49(7): 770-6.
FIP Statement of Policy on the effective utilisation of pharmacists in improving maternal, newborn and child health 2013.
Heitmann K, Solheimsnes A, Havnen GC, Nordeng H, Holst L. Treatment of nausea and vomiting during pregnancy -a cross-sectional study among 712 Norwegian women. Eur J Clin Pharmacol 2016; 72(5): 593-604.
Mulder B, Bijlsma MJ, Schuiling-Veninga CCM, et al. Risks versus benefits of medication use during pregnancy: What do women perceive? Patient Prefer Adherence 2017; 12: 1-8.
Nordeng H, Koren G, Einarson A. Pregnant women’s beliefs about medications--a study among 866 Norwegian women. Ann Pharmacother 2010; 44(9): 1478-84.
Twigg MJ, Lupattelli A, Nordeng H. Women’s beliefs about medication use during their pregnancy: A UK perspective. Int J Clin Pharm 2016; 38(4): 968-76.
Patel JP, Auyeung V, Patel RK, et al. Women’s views on and adherence to low-molecular-weight heparin therapy during pregnancy and the puerperium. J Thromb Haemost 2012; 10(12): 2526-34.
Goodman JH. Women’s attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth 2009; 36(1): 60-9.
Selinger CP, Eaden J, Selby W, et al. Inflammatory bowel disease and pregnancy: lack of knowledge is associated with negative views. J Crohn’s Colitis 2013; 7(6): e206-13.
Jasper JD, Goel R, Einarson A, Gallo M, Koren G. Effects of framing on teratogenic risk perception in pregnant women. Lancet 2001; 358(9289): 1237-8.
Bonari L, Koren G, Einarson TR, Jasper JD, Taddio A, Einarson A. Use of antidepressants by pregnant women: Evaluation of perception of risk, efficacy of evidence based counseling and determinants of decision making. Arch Women Ment Health 2005; 8(4): 214-20.
Lupattelli A, Picinardi M, Einarson A, Nordeng H. Health literacy and its association with perception of teratogenic risks and health behavior during pregnancy. Patient Educ Couns 2014; 96(2): 171-8.
Duggan L, McCarthy S, Curtis LM, et al. Associations between health literacy and beliefs about medicines in an Irish obstetric population. J Health Commun 2014; 19(Suppl. 2): 106-14.
Petersen I, McCrea RL, Lupattelli A, Nordeng H. Women’s perception of risks of adverse fetal pregnancy outcomes: A large-scale multinational survey. BMJ Open 2015; 5(6): e007390.
Widnes SF, Schjøtt J, Eide GE, Granas AG. Teratogenic risk perception and confidence in use of medicines in pairs of pregnant women and general practitioners based on patient information leaflets. Drug Saf 2013; 36(6): 481-9.
Hydery T, Price MK, Greenwood BC, et al. Evaluation of Progesterone Utilization and Birth Outcomes in a State Medicaid Plan. Pharmacotherapy 2017; 37(10): 1328-34.
Lupattelli A, Spigset O, Björnsdóttir I, et al. Patterns and factors associated with low adherence to psychotropic medications during pregnancy--a cross-sectional, multinational web-based study. Depress Anxiety 2015; 32(6): 426-36.
Wu J, Davis-Ajami ML. Antidepressant treatment persistence in low-income, insured pregnant women. J Manag Care Spec Pharm 2014; 20(6): 631-7.
Abheiden CN, van Reuler AV, Fuijkschot WW, de Vries JI, Thijs A, de Boer MA. Aspirin adherence during high-risk pregnancies, a questionnaire study. Pregnancy Hypertens 2016; 6(4): 350-5.
Nielsen MJ, Nørgaard M, Holland-Fisher P, Christensen LA. Self-reported antenatal adherence to medical treatment among pregnant women with Crohn’s disease. Aliment Pharmacol Ther 2010; 32(1): 49-58.
Julsgaard M, Nørgaard M, Hvas CL, Buck D, Christensen LA. Self-reported adherence to medical treatment prior to and during pregnancy among women with ulcerative colitis. Inflamm Bowel Dis 2011; 17(7): 1573-80.
Baarnes CB, Hansen AV, Ulrik CS. Enrolment in an Asthma Management Program during Pregnancy and Adherence with Inhaled Corticosteroids: The ‘Management of Asthma during Pregnancy’. Program Respiration 2016; 92(1): 9-15.
Lupattelli A, Spigset O, Nordeng H. Adherence to medication for chronic disorders during pregnancy: results from a multinational study. Int J Clin Pharm 2014; 36(1): 145-53.
Juch H, Lupattelli A, Ystrom E, Verheyen S, Nordeng H. Medication adherence among pregnant women with hypothyroidism-missed opportunities to improve reproductive health? A cross-sectional, web-based study. Patient Educ Couns 2016; 99(10): 1699-707.
Sawicki E, Stewart K, Wong S, Leung L, Paul E, George J. Medication use for chronic health conditions by pregnant women attending an Australian maternity hospital. Aust N Z J Obstet Gynaecol 2011; 51(4): 333-8.
Odalović M, Milanković S, Holst L, Nordeng H, Heitmann K, Tasić L. Pharmacists counselling of pregnant women: Web-based, comparative study between Serbia and Norway. Midwifery 2016; 40: 79-86.
Damase-Michel C, Vié C, Lacroix I, Lapeyre-Mestre M, Montastruc JL. Drug counselling in pregnancy: An opinion survey of French community pharmacists. Pharmacoepidemiol Drug Saf 2004; 13(10): 711-5.
Schrempp S, Ryan-Haddad A, Gait KA. Pharmacist counseling of pregnant or lactating women. J Am Pharm Assoc (Wash) 2001; 41(6): 887-90.
Lyszkiewicz DA, Gerichhausen S, Björnsdóttir I, Einarson TR, Koren G, Einarson A. Evidence based information on drug use during pregnancy: A survey of community pharmacists in three countries. Pharm World Sci 2001; 23(2): 76-81.
Bains S, Kitutu FE, Rahhal A, Abu Samaha R, Wilby KJ, Rowe H. Comparison of pharmacist knowledge, perceptions and training opportunities regarding maternal-fetal medicine in Canada, Qatar and Uganda. Can Pharm J 2014; 147(6): 345-51.
McAuley JW, Casey J, Long L. An evaluation of pharmacists’ knowledge of women’s issues in epilepsy. Epilepsy Behav 2009; 14(1): 243-6.
Hutchinson S, Mitchell K, Hansford D, Stewart D. Community pharmacists’ views and experiences of counter-prescribing in pregnancy. Int J Pharm Pract 2011; 9: 15-21.
Zehnder S, Beutler M, Bruppacher R, Ehrenhöfer T, Hersberger KE. Needs and use of drug information sources in community pharmacies: A questionnaire based survey in German-speaking Switzerland. Pharm World Sci 2004; 26(4): 197-202.
Tan MP, Koren G. Teratogen information service for pharmacists: A pilot study. J Popul Ther Clin Pharmacol 2011; 18(2): e377-89.
Gatti ME, Jacobson KL, Gazmararian JA, Schmotzer B, Kripalani S. Relationships between beliefs about medications and adherence. Am J Health Syst Pharm 2009; 66(7): 657-64.
Mårdby AC, Akerlind I, Jörgensen T. Beliefs about medicines and self-reported adherence among pharmacy clients. Patient Educ Couns 2007; 69(1-3): 158-64.
Foot H, La Caze A, Gujral G, Cottrell N. The necessity-concerns framework predicts adherence to medication in multiple illness conditions: A meta-analysis. Patient Educ Couns 2016; 99(5): 706-17.
Widnes SF, Schjøtt J, Granas AG. Risk perception and medicines information needs in pregnant women with epilepsy--a qualitative study. Seizure 2012; 21(8): 597-602.
Horne R, Chapman SC, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: A meta-analytic review of the Necessity-Concerns Framework. PLoS One 2013; 8(12): e80633.
Conover EA, Polifka JE. The art and science of teratogen risk communication. Am J Med Genet C Semin Med Genet 2011; 157C(3): 227-33.
Van Calsteren K, Gersak K, Sundseth H, et al. Position statement from the European Board and College of Obstetrics & Gynaecology (EBCOG): The use of medicines during pregnancy - call for action. Eur J Obstet Gynecol Reprod Biol 2016; 201: 189-91.
Oladejo M, Bewley S. Adherence in pregnancy: A systematic review of the literature. Fetal Matern Med Rev 2012; 23: 201-29.
Matsui D. Adherence with drug therapy in pregnancy. Obstet Gynecol Int 2012; 2012: 796590.
Nguyen TM, La Caze A, Cottrell N. What are validated self-report adherence scales really measuring?: A systematic review. Br J Clin Pharmacol 2014; 77(3): 427-45.
Liekens S, Vandael E, Roter D, et al. Impact of training on pharmacists’ counseling of patients starting antidepressant therapy. Patient Educ Couns 2014; 94(1): 110-5.
Watson M, Norris P, Granas A. A systematic review of the use of simulated patients and pharmacy practice research. Int J Pharm Pract 2006; 14: 83-93.
Harden RM. What is an OSCE? Med Teach 1988; 10(1): 19-22.
Austin Z, O’Byrne C, Pugsley J, Munoz LQ. Development and validation processes for an objective structured clinical examination (OSCE) for entry-to-practice certification in pharmacy: The canadian experience. Am J Pharm Educ 2003; 67: 76.
Sturpe DA. Objective structured clinical examinations in doctor of pharmacy programs in the United States. Am J Pharm Educ 2010; 74(8): 148.
Shirwaikar A. Objective structured clinical examination (OSCE) in pharmacy education - a trend. Pharm Pract (Granada) 2015; 13(4): 627.

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