Pregnant women are impacted by a lack of adherence to national prescribing guidance by healthcare professionals and an unwillingness to prescribe and dispense recommended medications, a new study has found.
The researchers believe their findings highlight the tendency of health professionals to overestimate the teratogenic potential of drugs, putting the health of pregnant women at risk.
Prescribing, dispensing and taking of some advised medications during pregnancy was found to be restricted through both a woman’s or a prescriber’s fear of fetal harm. Poor communications and differing professional opinions between those who prescribe to pregnant women in the UK, including GPs, midwives and obstetricians, led to fragmented prescribing and conflicting opinions.
When women wanted to take medication during pregnancy, the study shows they had to navigate complicated prescribing pathways to obtain it. In some cases, pharmacists refused to dispense prescriptions made by GPs.
The research, published in BMJ Open, involved researchers at University College London (UCL), the British Pregnancy Advisory Service (BPAS), Cardiff University, and Pregnancy Sickness Support, and calls for better translation of national guidance for antenatal care and a more personalised approach to care for women.
There are a few medications, including thalidomide, sodium valproate and isotretinoin which women should not use during pregnancy due to the high risk of foetal abnormalities. However, most other medicines are safe to use during pregnancy, and several national prescribing guidelines exist for treatment.
The researchers looked at women’s experiences of over-the-counter and prescription medication advice and use during pregnancy by surveying 7090 women between the age of 16 and 45. Each woman had been pregnant in the last five years and was UK based.
All participants completed an online survey assessing their experiences, and a subset of 34 participants were interviewed in more detail. The results were combined with the survey answers using thematic analysis, a method used to analyse qualitative results and highlight common themes and patterns in the data.
The findings showed that healthcare professionals were not following national prescribing guidance and often held conflicting professional opinions, leading to maternal anxiety and, in some cases, serious health issues, exacerbating symptoms resulting in hospitalisation.
Women reported feeling guilty or like ‘the worst mother’ for seeking medication to treat serious conditions such as severe sickness, pregnancy pain and mental health conditions.
Some participants reported being repeatedly warned by healthcare workers that medication could harm their foetus, even after the medication had been prescribed, with some women choosing to discontinue their prescribed treatments due to fears about foetal harm. Participants sometimes resorted to self-prescribing due to the complexity of navigating prescribing pathways.
In contrast, other women felt overmedicated and that pharmacological treatments were used without exploring other options first.
Clare Murphy, Chief Executive of BPAS, said: ‘The vast majority of pregnant women in the UK will need to use medication for a short-term or chronic condition, and safe and effective prescribing is an essential component of antenatal care. Yet it is clear from our research that women’s health and wellbeing are being harmed by an overly precautionary approach.’
She added: ‘We need to challenge the prevailing cultural climate in which pregnant women’s own needs are often seen as secondary to those of her foetus because, as our research shows, this can have serious consequences for women.’
The researchers advised that prescribers should balance maternal benefit with potential foetal harm when prescribing in pregnancy and examine an individual’s circumstances more fully, including the patient in the decision making process.
Professor Julia Sanders, from Cardiff University, added: ‘This study shows all professional groups need to work harder to ensure women are able to access safe, effective medicines throughout pregnancy.’
