Pregnant women facing prescription medication inequalities

Pregnant women facing prescription medication inequalities
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A new study finds unwillingness to prescribe recommended medications is putting the health and lives of pregnant women at risk.

New research involving investigators at the University College London (UCL), the Centre for Reproductive Research & Communication at BPAS, Cardiff University, and Pregnancy Sickness Support highlighted the experiences of pregnant women whose pharmacists refused to dispense prescriptions made by their GP.

The study analysed data from 7,090 women and interviews with 34 women who were pregnant or had been pregnant in the last five years, to understand how pregnant women were prescribed and dispensed medications.

The research is published in BMJ Open.

Pregnant women are resorting to self-prescribing

Following their analysis, the team found that women were made to feel “guilty” or like “the worst mother” for seeking medication to treat serious medical conditions.

Several participants resorted to self-prescribing and discontinued their advised treatments without medical consultation due to fears of harming their babies. This then leads to hospitalisation or worsened symptoms.

As a result, the researchers are calling for healthcare professionals to “work harder to ensure pregnant women can access the right medicines for themselves and their baby”.

Co-author Professor Irene Petersen (UCL Institute of Epidemiology & Health) said: “The findings in this study match what we have seen when we have studied pregnant women’s electronic health records. Many medications are discontinued leaving many pregnant women without the treatment that they need.”

Most medications are safe during pregnancy

Few medications should not be used by pregnant women due to their teratogenicity (the ability of a drug to cause foetal abnormalities or deformities). These include thalidomide, sodium valproate and isotretinoin.

However, most other medications are safe and used during pregnancy, and there are several national prescribing guidelines for treatment during pregnancy.

It is important that prescribers balance maternal benefit with potential foetal harm when prescribing to pregnant women; however, women’s circumstances are often not considered. Even once the pregnant women were prescribed medication, they were warned repeatedly by healthcare professionals that taking the medication could result in harm to the baby. This led to the women feeling reluctant to use the medications and feeling shamed or guilty.

The researchers believe this may reflect how healthcare professionals overestimate the teratogenic potential of drugs.

Clare Murphy, Chief Executive of the British Pregnancy Advisory Service (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.

“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.”

In the UK, pregnant women can be prescribed medications by a range of healthcare professionals, including GPs and midwives, leading to fragmented prescribing and mixed opinions.

Julia Sanders, Professor of Clinical Midwifery at Cardiff University, said: “During the study, we heard from many pregnant women who could not access the medications they needed. This is particularly related to medicines for a severe sickness, pregnancy pain and mental health conditions.

“Some women were blocked from getting recommended medicines because doctors would not prescribe them or pharmacists refused to dispense them. Other women were prescribed medicines, but a lack of information meant they did not have the confidence to take them.

“This study shows all professional groups need to work harder to ensure women are able to access safe effective medicines throughout pregnancy.”

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