Use of medications by pregnant women in the Family Health Strategy in the Northeast of Brazil

Campos, Hudson Manoel Nogueira; Mattos, Mússio Pirajá; Gomes, Daiene Rosa

doi:10.1590/1806-9304202200040014

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 22 (04) • Oct-Dec 2022 • https://doi.org/10.1590/1806-9304202200040014 copy

Use of medications by pregnant women in the Family Health Strategy in the Northeast of Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

To evaluate the medication use, exposure to potential risks, and associated factors before and during pregnancy of pregnant women receiving care at the Family Health Strategy in a municipality in the Northeast of Brazil.

Methods:

This is a cross-sectional study of pregnant women receiving care in the municipality of Barreiras, in Bahia, Brazil. In data analysis process, prevalence and frequency of medication use were estimated. To investigate the association between variables, the outcome measure was expressed by the prevalence ratio (crude and adjusted) with a 95% confidence interval via Poisson regression.

Results:

The prevalence of medication use before pregnancy was 35% and during pregnancy, it was 80.7%. Analgesics and antianemics were the prevalent groups of medications before and during pregnancy, respectively. Family income (≤1 minimum wage; PR=1.62; CI95%=1.02-2.55) showed an association with prior use; health problems (PR=2.3; CI95%=1.27-4.22) and complaints in pregnancy (PR=2.39; CI95%=1.28-4.47) had an association with use during pregnancy.

Conclusion:

The characterization of a high prevalence of use of medicines by pregnant women, combined with a trend of failures in family planning could demonstrate the exposure of the risks of using some harmful substances in periods close to conception and pregnancy.

Key words:
Drug utilization; Pregnant women; Pharmacoepidemiology; Prenatal care

Maternal characteristics	Pregnant women			Medications use during pregnancy			Medications use before pregnancy
Maternal characteristics	n	%	CI95%	n	%	CI95%	n	%	CI95%
Maternal age (years)
18 – 25	137	40.8	35.9 – 45.5	118	86.1	80.3 – 91.2	44	32.1	24.1 – 40.1
26 – 29	68	20.2	16.2 – 24.4	53	77.9	66.9 – 87.6	20	29.4	19.1 – 40.5
30 – 34	72	21.4	17.1 – 25.5	55	76.4	66.7 – 84.7	32	44.4	33.3 – 56.9
>34	59	17.6	13.2 – 22.3	45	76.3	64.4 – 86.4	22	37.3	25.4 – 49.2
Planned pregnancy
No	194	57.6	52.2 – 63.2	152	78.4	71.6 – 83.8	64	33.0	25.5 – 39.2
Yes	143	42.4	36.8 -47.8	120	83.9	77.6 – 90.2	54	37.8	29.7 – 46.9
Schooling (years)
≤ 8	27	8.1	1.4 – 5.4	22	81.5	66.7 – 96.3	11	40.7	22.2 – 63.0
9 – 11	88	26.4	21.9 – 31.5	65	73.9	63.6 – 83.0	24	27.3	18.2 – 37.5
> 11	218	65.5	60.4 – 70.6	181	83.0	78.7 – 88.1	82	37.6	31.2 – 44.8
Marital status
Without a partner	26	7.7	5.0 – 10.4	22	84.6	69.2 – 962	7	26.9	11.5 – 42.3
With a partner	311	92.3	89.6 – 95.0	250	80.4	75.6 – 85.1	111	35.7	30.7 – 41.5
Family income (minimum wage)
>1	95	28.2	23.4 – 32.9	72	75.8	66.3 – 83.2	23	24.2	16.3 – 32.6
≤1	242	71.8	67.1 -76.6	200	82.6	77.3 – 87.6	95	39.3	33.2 – 45.9
Economic class
A/B	59	17.5	13.6 – 22.6	49	83.1	72.9 – 93.2	23	39.0	27.1 – 50.8
C/D/E	278	82.5	77.4 – 86.4	223	80.2	75.5 – 84.5	95	34.2	28.8 – 39.8
Skin color
Non-black *	268	79.5	75.2 – 83.4	215	80.2	75.5 – 85.4	95	35.4	29.9 – 41.6
Black	69	20.5	16.6 – 24.8	57	82.6	73.1 – 92.1	23	33.3	23.2 – 44.9
Smoker
No	326	96.7	95.0 -98.5	264	81.0	76.4 – 85.0	115	35.3	30.1 – 40.0
Yes	11	3.0	1.5 - 5	8	72.7	45.5 – 100.0	3	27.3	4.2 – 54.5
Alcohol consumption
No	284	84.3	80.3 – 88.3	234	82.4	77.8 – 87.0	101	35.6	30.6 – 41.2
Yes	53	15.7	11.7 – 19.7	38	71.7	58.5 – 84.9	17	32.1	20.8 – 44.4
Number of previous pregnancies
≥2	117	34.7	29.7 – 39.9	96	82.1	74.4 – 88.9	38	32.5	23.5 – 41.9
<2	220	65.3	60.1 – 70.3	176	80.0	74.1 – 85.5	80	36.4	29.1 – 43.6
History of miscarriage
No	252	74.8	69.7 – 78.9	206	81.7	76.2 – 85.9	90	35.7	29.7 – 41.7
Yes	85	25.2	21.1 – 30.3	66	77.6	69.4 – 85.9	28	32.9	22.4 – 43.5
Start of pre-natal care
During the 1^st trimester	285	84.6	79.8 -88.6	231	81.1	75.6- 85.6	100	35.1	29.6 – 40.7
After the 1^st trimester	52	15.4	11.4 – 20.2	41	78.8	67.3 – 90.4	18	34.6	19.2 – 46.2
Number of pre-natal consultations
≤3	127	37.7	32.6 – 43.0	95	74.8	66.5- 81.9	43	33.9	25.6 -42.9
>3	210	62.3	57.0 – 67.4	177	84.3	78.6 – 89.0	75	35.7	28.3 -42.4
Having any of the following health problems **
No	175	51.9	45.8 – 57.1	129	73.7	66.5 – 80.3	58	33.1	26.5 – 40.0
Yes	162	48.1	42.9 – 54.2	143	88.3	83.3 – 93.2	60	37.0	29.3 – 44.8
Having the following complaints in pregnancy ^#
No	65	19.3	14.5 – 23.7	43	66.2	55.4 – 77.8	20	30.8	19.2 – 43.1
Yes	272	80.7	76.3 – 85.5	229	84.2	79.6 – 88.2	98	36.0	30.1 – 41.9

ATC Classification	Pregnant women*
	During pregnancy		Before pregnancy
	n	%	n	%
Blood and hematopoietic organs – B	217	64.4	13	3.9
Antianemics - B03	217	64.4	9	2.7
Iron-containing drugs - B03A	193	57.3	2	0.6
Vitamin B12 and folic acid - B03B	192	57.0	9	2.7
Antithrombotic agents - B01	1	0.3	2	0.6
Plasma substitutes and perfusion solutions - B05	0	-	1	0.3
Irrigation solutions - B05C	0	-	1	0.3
Gastrointestinal Tract and Metabolism– A	103	30.6	23	6.8
Vitamins - A11	75	22.3	4	1.2
Multivitamin combinations - A11A	10	3.0	3	0.9
Vitamins A and D - A11C	8	2.4	0	-
Ascorbic acid including associations - A11G	40	11.9	0	-
Other Vitamins Alone - A11H	1	0.3	0	-
Other vitamin combinations - A11J	9	2.7	1	0.3
Treatment of functional disorders of the stomach and intestines - A03	17	5.0	9	2.7
Drugs for treatment of functional disorders of the gastrointestinal tract - A03A	3	0.9	0	-
Belladonna and derivatives, isolated - A03B	6	1.8	9	2.7
Antispasmodics in association with analgesics - A03D	8	2.4	0	-
Treatment of acid related disorders - A02	3	0.9	4	1.2
Antacids - A02A	3	0.9	1	0.3
Drugs for the treatment of peptic ulcer disease and gastroesophageal reflux - A02B	0	-	2	0.6
Drugs used in diabetes - A10	2	0.6	3	0.9
Insulins and analogues - A10A	1	0.3	2	0.6
Antidiabetics, excluding insulins - A10B	1	0.3	1	0.3
Mineral Supplements - A12	1	0.3	2	0.6
Calcium - A12A	1	0,3	2	0.6
Anti-emetics and anti-vertigo - A04	9	2.7	1	0.3
Digestives, including enzymes - A09	0	-	1	0.3
Central Nervous System– N	48	14.2	50	14.8
Analgesics - N02	48	14.2	43	12.8
Opiates - N02A	0	-	2	0.6
Other analgesics and antipyretics - N02B	47	13.9	37	11.0
Drugs used in migraine - N02C	1	0.3	2	0.6
Anti-epileptics - N03	0	-	2	0.6
Anti-epileptics - N03A	0	-	2	0.6
Psychleptics - N05	2	0.6	3	0.9
Antipsychotics - N05A	1	0.3	1	0.3
Anxiolytics - N05B	0	-	1	0.3
Psychokanalleptics - N06	0	-	3	0.9
Antidepressants - N06A	0	-	3	0.9
Other nervous system drugs - N07	0	-	1	0.3
Antivertigo drugs - N07C	0	-	1	0.3
Cardiovascular system– C	20	5.9	7	2.1
Antihypertensives - C02	14	4.2	0	-
Centrally acting anti-adrenergic agents - C02A	14	4.2	0	-
Beta-Adrenergic Receptor Blockers - C07	0	-	4	1.2
Beta Adrenergic Receptor Blocking Agents - C07A	0	-	3	0.9
Beta adrenergic receptor blocking agents associated with other antihypertensive agents - C07F	0	-	1	0.3
Anti-dyslipidemics - C10	6	1.8	1	0.3
Lipid-modifying drugs, isolated - C10A	6	1.8	1	0.3
Agents with action on the renin-angiotensin system - C09	0	-	2	0.6
ACE inhibitors - C09A	0	-	2	0.6
Diuretics - C03	0	-	1	0.3
Thiazide diuretics - C03A	0	-	1	0.3
Anti-infectives for systemic use – J	16	4.7	3	0.9
Antibacterials for systemic use - J01	15	4.5	2	0.6
Beta-lactam antibacterials, penicillins - J01C	3	0.9	2	0.6
Macrolides, Lincosamides and Streptogramins - J01F	3	0.9	0	-
Quinolones - J01M	1	0.3	0	-
Other antibacterials - J01X	8	2.4	0	-
Antimycobacterials - J04	1	0.3	1	0.3
Drugs used in the treatment of tuberculosis - J04A	1	0.3	1	0.3
Genito-urinary system and sex hormones – G	4	1.2	31	9.2
Infectives and antiseptics for gynecology - G01	1	0.3	0	-
Anti-infectives and antiseptics, excluding combinations with corticosteroids - G01A	1	0.3	0	-
Sex hormones and modulators of the genital system - G03	3	0.9	31	9.2
Hormonal contraceptives for systemic use - G03A	0	-	20	5.9
Antiandrogens - G03H	0	-	10	3.0
Progestogens or progestins - G03D	3	0.9	0	-
Progestogens or progestins associated with estrogens - G03F	0	-	1	0.3
Hormonal systemic preparations – H	2	0.6	4	1.2
Corticosteroids for systemic use - H02	0	-	1	0.3
Corticosteroids for systemic use alone - H02A	0	-	1	0.3
Thyroid therapy - H03	2	0.6	3	0.9
Thyroid preparations - H03A	2	0.6	3	0.9
Iodine therapy - H03C	-	-	1	0.3
Musculoskeletal System – M	2	0.6	13	3.9
Anti-inflammatory and anti-rheumatic drugs - M01	1	0.3	3	0.9
Non-steroidal anti-inflammatory and anti-rheumatic drugs - M01A	1	0.3	3	0.9
Muscle relaxants - M03	1	0.3	10	3.0
Centrally acting muscle relaxants - M03B	1	0.3	10	3.0
Respiratory system – R	2	0.6	1	0.3
Nasal therapy - R01	1	0.3	0	-
Decongestants and other topical nasal drugs - R01A	1	0.3	0	-
Drugs for the treatment of obstructive respiratory diseases - R03	0	-	1	0.3
Adrenergic Inhalation Drugs - R03A	0	-	1	0.3
Other inhalation medicinal products for the treatment of obstructive respiratory diseases - R03B	0	-	1	0,3
Cough and cold medicines - R05	1	0.3	0	-
Expectorants, excluding combinations with anti-cough medicines - R05C	1	0.3	0	-
Antihistamines for systemic use - R06	1	0.3	0	-
Antihistamines for systemic use - R06A	1	0.3	0	-
Antineoplastic and immunomodulatory agents – L	0	-	2	0.6
Antineoplastic agents - L01	0	-	1	0.3
Cytotoxic antibiotics and related substances - L01D	0	-	1	0.3
Immunosuppressants - L04	0	-	1	0.3
Immunosuppressants - L04A	0	-	1	0.3
Anti-parasitic products, insecticides and repellents – P	0	-	1	0.3
Antiprotozoals - P01	0	-	1	0.3
Antimalarials - P01B			1	0.3
Others	11	3.3	10	3.0
Total	337	421.4	337	135.3

ATC Classification	Medications
	During pregnancy		Before pregnancy
	n	%	n	%
Blood and hematopoietic organs – B	395	63.4	14	8.1
Gastrointestinal tract and metabolism – A	116	18.6	25	14.5
Central nervous system – N	52	8.3	58	33.5
Cardiovascular system – C	21	3.4	9	5.2
Anti-infectives for systemic use – J	17	2.7	3	1.7
Genitourinary system and sex hormones – G	4	0.6	31	17.9
Respiratory system – R	3	0.5	2	1.2
Hormonal systemic preparations – H	2	0.3	5	2.9
Musculoskeletal system – M	2	0.3	13	7.5
Antineoplastic and immunomodulatory agents – L	0	-	2	1.2
Anti-parasitic products, insecticides and repellents – P	0	-	1	0.6
Others	11	1.8	10	5.8
FDA risk of drug use in pregnancy
A	474	76.0	22	13.0
B	63	10.0	19	11.0
C	69	11.1	72	42.0
D	4	0.6	12	7.0
X	2	0.3	38	22.0
Unclassified	11	1.8	10	6.0
Risk of medication use during pregnancy according to ANVISA
Indicated	454	73.0	26	15.0
Contraindicated	30	5.0	100	58.0
Use with caution	128	21.0	37	21.0
No information	11	2.0	10	6.0
Total	623	100.0	173	100.0

Maternal characteristics	Prior to pregnancy		During pregnancy
Maternal characteristics	PR (CI95%)	PRa (CI95%)	PR (CI95%)	PRa (CI95%)
Maternal age (years)
18 – 25	1.0	1.0	1.0	-
26 – 29	0.91 (0.53 – 1.55)	0.87 (0.51 – 1.49)*	0.90 (0.65 – 1.25)	-
30 – 34	1.38 (0.87 – 2.18)	1.31 (0.81 – 2.12)*	0.88 (0.64 – 1.22)	-
>34	1.16 (0.69 – 1.93)	1.09 (0.63 – 1.87)*	0.88 (0.62 – 1.24)	-
Planned pregnancy
No	1.0	-	1.0	-
Yes	1.14 (0.79 – 1.64)	-	1.07 (0.84 – 1.36)	-
Schooling (years)
≤ 8	1.00	-	1.0	-
9 – 11	0.66 (0.32 – 1.36)	-	0.90 (0.55 – 1.47)	-
> 11	0.92 (0.49 – 1.73)	-	1.01 (0.65 – 1.58)	-
Marital status
Without a partner	1.0	-	1.0	-
With a partner	1.32 (0.61 – 2.84)	-	0.95 (0.61 – 1.46)	-
Family income (minimum wage)
>1	1.0	1.0	1.0	-
≤1	1.62 (1.02 – 2. 55)	1.63 (1.03 – 2.58)*	1.09 (0.83 – 1.42)	-
Economic class
A/B	1.0	-	1.0	-
C/D/E	0.87 (0.55 – 1.38)	-	0.96 (0.70 – 1.31)	-
Skin color
Non-black *	1.0	-	1.0	-
Black	0.94 (0.59 – 1.48)	-	1.02 (0.76 – 1.37)	-
Smoker
No	1.0	-	1.0	-
Yes	0.77 (0.24 – 2.43)	-	0.89 (0.44 – 1.81)	-
Alcohol consumption
No	1.0	-	1.0	-
Yes	0.90 (0.53 – 1.50)	-	0.87 (0.61 – 1.22)	-
Number of previous pregnancies
≥2	1.0	1.0	1.0	-
<2	1.13 (0.77 – 1.66)	1.09 (0.71 – 1.66)*	0.97 (0.75 – 1.24)	-
History of miscarriage
No	1.0	-	1.0	-
Yes	0.92 (0.60 – 1.40)	-	0.94 (0.71 – 1.25)	-
Start of pre-natal care
During the 1^st trimester	1.0	-	1.0	-
After the 1^st trimester	0.98 (0.59 – 1.62)	-	0.97 (0.69 – 1.35)	-
Number of pre-natal consultations
≤3	1.0	-	1.0	1.0
>3	1.05 (0.72 – 1.53)	-	1.80 (1.04 – 3.12)	1.61 (0.91 – 2.85)*
Having any health problems **
No	1.0	-	1.0	1.0
Yes	1.11 (0.77 – 1.60)	-	2.68 (1.49 – 4.81)	2.32 (1.27 – 4.22)*
Having complaints in pregnancy^#
No	1.0	-	1,0	1.0
Yes	1.17 (0.72 – 1.89)	-	2.72 (1.48 – 5.00)	2.39 (1.28 – 4.47)*

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[TFN1] CI95% = 95% confidence interval; * Pregnant women who self-reported being yellow, white or indigenous; ** Anemia, asthma, tuberculosis, pneumonia, diabetes, hypertension, kidney disease, urinary infection, and hemorrhoids; ^# Nausea, vomiting, pain, fever, gases, heartburn, inflammation, constipation, headache, abdominal colic, diarrhea, and lack of appetite.

[TFN2] Note: There are losses in some variables.