Abstract:

Background: Pregnancy is the time of profound physiological changes in a female’s body. Maternal drug use during pregnancy may pose a teratogenicity risk to the fetus. However, the fact that drugs are needed to mitigate the complications during pregnancy cannot be avoided, therefore, this study is designed to assess prenatal drug prescription pattern at Mbabane Government Hospital.

Objectives: Assess prenatal drug prescription patterns at the gynecology and maternity wards at Mbabane Government Hospital in Swaziland.

Methodology: A retrospective study was conducted at the maternity and gynecology wards at Mbabane Government Hospital from 3^rd – 14^th of July 2017. Data was retrieved from in-patient medical records.

Results: The study was done by enrolling 218 pregnant women. The most commonly prescribed drugs were the antimicrobial, NSAIDs, nutritional supplements, parenteral solutions and analgesics. The least prescribed were anticonvulsants. A high proportion were prescribed from US-FDA category B (42%), followed by category C (36%) and category A (9%). A small percentage of drugs (6%) were prescribed from drugs with positive evidence of risk (US-FDA category D) and (7%) were prescribed from drugs with proven fetal risk (category X).

Conclusion/ Recommendations: A considerable proportion of pregnant women were exposed to drugs, including those with positive evidence of risk and those with proven fetal risk. Healthcare providers must adopt the US-FDA risk category system when prescribing drugs to pregnant women.

Keywords: Prenatal; drug prescription pattern; US-FDA pregnancy category.

References:

[1].     Al-Humayyd MS, Babay ZH, 2016. Patterns of Drug Prescribing During Pregnancy in Saudi Women: a Retrospective Study. SPJ 14:201-7. Available at http://www.ncbi.nlm.nih.gov. Accessed on 25 July 2017.

[2].     Al-Hamimi JZ, Al-Balushi, 2016. Patterns of Prescription Drug Use among Pregnant Women at Sultan Qaboos University Hospital and Sultan Qaboos University Hospital Family and Community Medicine Clinic, Oman. JPBS 8(4):309-313 Available at http://www.ncbi.nlm.nih.gov. Accessed on 25 July 2017.

[3].     Andrede SE, Gurwitz JH, Davis RL, Chan KA, Finkelstein JA, Fortman K, et al, 2014. Prescription Drug Use in Pregnancy. AJOG; 191:398-407. Available at http://www.ncbi.nlm.nih.gov. Accessed on 22 July 2017.

[4].     Annual Regional Shiselweni Health Performance Report (ARSHPR), 2015. Strategic Information Department, Kingdom of Swaziland Ministry of Health; USAID, IHM, PEPFAR.

[5].     Annual Regional Hhohho Health Performance Report (ARHHPR), 2015. Strategic Information Department, Kingdom of Swaziland Ministry of Health; USAID, IHM, PEPFAR.

[6].     Arnold C, Christopher PH, Bernadette M, 2013. March of Dimes; Global Reports on Birth Defects. Available at http://www.marchofdimes.org. Accessed on 11 April 2017.

[7].     Beyens MN, Guy C, Ratrema M, Ollagner M., 2003. Prescription of drugs to pregnant women in France: the HIMAGE study. Therapie. 58:505-11. Available at http://www.ncbi.nlm.nih.gov. Accessed on 07 November 2016.

[8].     Cunningham GF, MacDonald PC, Leveno KJ, Gant NF, Galstrap LC, 2005. Williams Obstetrics. 22^nd edition. New York. McGraw Hill: 341-71. Available at http://www.ncbi.nlm.nih.gov. Accessed on 07 November 2016.

[9].     Sarker DC, Datta A, Bohra S, 2013. A Study of Drug Use during Pregnancy in a Teaching Hospital in Western Napal. Pharmacoepidemiology and Drug Safety, 12:221-225 Available at http://www.ncbi.nlm.nih.gov. Accessed on 22 July 2017.

[10].  Daw JR, Hanly GE, Greyson DL, Morgan SG, 2011. Prescription Drug Use During Pregnancy In Developed Countries: A systemic Review. PEDS; 20; 895-902. Available at http://www.ncbi.nlm.nih.gov. Accessed on 22 July 2017.

[11].  Fatima T, Fatima H, Hasbeen S, Md. Ashfaq H, Roya R. 2015. Prescription pattern of drugs in pregnancy: a review. IRJP. Available at: http://www.ncbi.nlm.nih.gov. Accessed on 17 December 2016,

[12].  FDA Pregnancy category, compiled by Northwest. Accessed on 15 December 2016, available at http://depts.washington.edu/druginfo/Formulary/Pregnancy.pdf. Accessed on 29 November 2016.

[13].  Gawde SR, Bhide SS, Patel TC, Chauhan AR, Mayadeo NM, Sawardeka SB, 2013. Drug Prescription Pattern in Pregnant Women Attending Antenatal Out-patient Department of a Tertiary Care Hospital. BJPR vol 3(1):1-12. Available at: http://www.sciencedomain.org . Accessed on 02 November 2016.

[14].  Harsh J, Sejal P, Kamlesh P, Varsha P, 2012. Drug use patterns during pregnancy. A Retrospective Study at Tertiary Care Teaching Hospital. NHLJMS vol 1(1). Available at http://www.ncbi.nlm.nih.gov. Accessed on 02 November 2016.

[15].  Hafany SA, Sallam SA, Ibrahim FK, Iman HW, 2016. Drug Utilization Pattern during Pregnancy in Alexandria, Egypt. EJPMR; 3(2), 19-29. Available at http://www.ncbi.nlm.nih.gov. Accessed on 22 July 2017.

[16].  Kasaye E. Mesfin HK, 2015. Assessment of Drug Prescription Patterns among Pregnant Women Attending Antenatal Care in Health Centers Found Sub City, in Addis Ababa, Ethopia. JPSBR 5(4):347-362). Available at: http://www.sciencedomain.org . Accessed on 02 November 2016.

[17].  Kebede B, Gedif T, Gatachew A, 2009. Assessment of Drug Use among Pregnant Women in Addis Ababa, Ethiopia. PEDS; 18:462-8. Available at http://www.ncbi.nlm.nih.gov. Accessed on 22 July 2017.

[18].  Kumarjit S, Majunath GN, Dhananjaya BS, Lshit K, 2015. Prescription Pattern of Drugs during Pregnancy in a Tertiary Care Center: A Retrospective study. JIMD 2(1):330-35. Available at: http://www.jimd.in. Accessed on 09 November 2016.

[19].  Malm H et al, Martikainen J, Klaukka T, Neuvonen PJ, 2004. Prescription of Hazardous Drugs during Pregnancy. Drug Safety 27:899-908. IRJP Available at: http://www.ncbi.nlm.nih.gov. Accessed on 09 December 2016.

[20].  McElhatton PR, 2003. General Principal of Drug Use in Pregnancy. PJ 270:232-4. Available at: http://www.nnbi.nlm.nih.gov. Accessed on 30 December 2016.

[21].  Merriam-Webster.com. Merriam-Webster, ND. Web. December 2016. Accessed on 04 January 2017. Available at: http://www.merriam-webster.com/dictionary/formulary. Accessed on 22 January 2017.

[22].  Mesfin F, Dereje K, Wote A, Fanta G, 2015. Drug Utilization Pattern and Potential Teratogenicity Risk among Pregnant Women Visiting Antenatal Clinic: Case of a Primary Hospital. IJOPP 8:1.6. Available at http://www.ncbi.nlm.nih.gov. Accessed on 27 July 2017.

[23].  Medical dictionary, 2016. Medical definition of prenatal. Available at: http://www.medicinenet.com. Accessed on 02 February 2017.

[24].  Mohammed AM, Jemal HA, Abdulhalik W, Hishan SA, 2013. Medication Used Among Pregnant Women in Ethiopia. a Cross Sectional Study. JAPS, vol 3(04):116-123. Available online at http://wwwjapsonline.com. Accessed on 07 November 2016.

[25].  Mutihir JT, Eka. Po., 2011. Stillbirts at the Jos University Teaching Hospital: Incidence, Risk and Etiological Factors, NJCP vol 14 (1): 14-18. [Online] . Available at: http://www.njcponline.com. Accessed 01 February 2017.

[26].  Ornella L, Seipati M. Patricia G. Stephan. M., n.d. Antenatal Care. [Online]
Available at: http://www.who.int/pnmc.../aonsectionIII-2. Accessed on 20 January 2017.

[27].  Ramesh D, Khan GM, Kadir A, Amish R, Binaya S, 2016. Medicinal Utilization Patterns for Management of Pregnancy Complications. A study in the Western Napal. BMCPC vol 16. Available at: http://www.ncbi.nlm.nih.gov. Accessed on 22 November 2016.

[28].  Reddy SR et al, Patil N, Hinchageri SS, Kamala S, 2011. Assessing the Pattern of Drug Use among Pregnant Women and Evaluating the Impact of Counseling on Medication Adherence among Them. IJP 2(8):148-53. Available at: http://www.ncbi.nlm.nih.gov. Accessed on 20 December 2016.

[29].  Riley EH, Afflick EF, Jackson RA, Escobar GJ, Brawarsky P, Schreiber M, 2015. Correlates Prescription Drug Use During Pregnancy. JWH. 14(5) Available at: http://www.ncbi.nlm.nih.gov. Accessed on 30 November 2016.

[30].  Standard Treatment Guideline and Essential Medical List of Common Medical Conditions in the Kingdom of Swaziland, 2012. 1 edition.

[31].  Uchenna IE, Adego EE, Azuka EO, Ehijei FE, 2007. Assessment of Prescription Profile of Pregnant Women Visiting Antenatal Clinics. PP vol 5(3):135-9. Available at: http://www.ncbi.nlm.nih.gov. Accessed on 30 November 2016.

[32].  US Pharmacists, 2017. Pregnancy and OTC Cough-cold and Analgesic Prescriptions. Available at: http://www.uspharmacists.com/article/pregnancy-and-otc-cough-cold-and-analgesic-prescription. Accessed on 03 February 2017.

[33].  Wen SW, Yang T, Krewski D, Yang Q, Nimrode C, Garner P. 2008. Patterns of Pregnancy Exposure to Prescriptions FDA C, D and X is the Canadian Population. JP28 (5):324-329. Available at: http://www.ncbi.nlm.nih.gov. Accessed on 30 November 2016.

[34].  WHO Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey, 2013-14. Available at: http://www.who.int/maternal-child-adolescent/document/countries/indicators/deshboards/en/. Accessed on 01 February 2017.