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Am J Perinatol 2022; 39(06): 623-632
DOI: 10.1055/s-0040-1717097
Original Article

Racial/Ethnic Differences in Prenatal Supplement and Medication Use in Low-Risk Pregnant Women

Yassaman Vafai
1   Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Edwina H. Yeung
1   Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Rajeshwari Sundaram
2   Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Melissa M. Smarr
3   Population Health Branch, Division of Extramural Research and Training, National Institute of Environmental Health Sciences, Durham, North Carolina
,
Nicole Gerlanc
4   Prospective Group Inc, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
William A. Grobman
5   Feinberg School of Medicine, Northwestern University, Chicago, Illinois
,
Daniel Skupski
6   New York Presbyterian Queens, Flushing, New York
,
Edward K. Chien
7   Women and Infants Hospital, Providence, Rhode Island
8   Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio
,
Stefanie N. Hinkle
1   Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Roger B. Newman
9   Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
,
Deborah A. Wing
10   University of California, Irvine, Orange, California
11   Fountain Valley Regional Hospital and Medical Center, Fountain Valley, California
,
Angela C. Ranzini
12   Saint Peter's University Hospital, New Brunswick, New Jersey
,
Anthony Sciscione
13   Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware
,
Jagteshwar Grewal
1   Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Cuilin Zhang
1   Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Katherine L. Grantz 
1   Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
› Author Affiliations Funding This research was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (contract numbers: HHSN275200800013C, HHSN275200800002I, HHSN27500006, HHSN275200800003IC, HHSN275200800014C, HHSN275200800012C, HHSN275200800028C, and HHSN275201000009C).
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Abstract

Objective This study aimed to describe the overall quantity and type of supplements and medications used during pregnancy in a low-risk cohort and to examine any racial/ethnic differences in intake.

Study Design We used data from 2,164 racially/ethnically diverse, nonobese, and low-risk pregnant women participating without pre-pregnancy chronic conditions in a prospective cohort study at 12 sites across the United States. Medication data were self-reported as free text in enrollment, follow-up visit questionnaires, and abstracted from medical records at delivery. Supplements and medications data were mapped to their active ingredients and categorized into corresponding classes using the Slone Drug Dictionary. The total number and classes of supplements and medications consumed during pregnancy were calculated. Modified Poisson regression models were used to estimate the racial/ethnic differences in supplements and medications intake. All models were adjusted for maternal sociodemographic factors and study site.

Results 98% of women took at least one supplement during pregnancy, with prenatal vitamins/multivitamins being most common. While only 31% reported taking no medications during pregnancy, 23% took one, 18% took two, and 28% took three or more. The percentage of women taking at least one medication during pregnancy was highest among non-Hispanic white women and lowest among Asians (84 vs. 55%, p < 0.001). All racial/ethnic groups reported taking the same top four medication classes including central nervous system agents, gastrointestinal drugs, anti-infective agents, and antihistamines. Compared with non-Hispanic white women, Hispanic (adjusted relative risk [aRR]: 0.84, 95% confidence interval [CI]: 0.71–0.98), and Asian women (aRR: 0.83, 95% CI: 0.70–0.98) were less likely to take central nervous system agents, as well as gastrointestinal drugs (Hispanics aRR: 0.79, 95% CI: 0.66–0.94; Asians aRR = 0.75, 95% CI: 0.63–0.90), and antihistamines (Hispanics aRR: 0.65, 95% CI: 0.47–0.92).

Conclusion Supplement intake was nearly universal. Medication use was also common among this low-risk pregnancy cohort and differed by race/ethnicity.

ClinicalTrials.gov Identifier NCT00912132.

Key Points

  • In women without chronic conditions, medication use is common.

  • Racial/ethnic differences exist in prenatal medications use.

  • Almost all women use supplements during pregnancy.

Keywords

pregnancy - medication intake - vitamins - medication classes - medication prevalence

Note

E.H.Y., S.N.H., R.R., J.G., C.Z., and K.L.G. are U.S. federal government employees.


Supplementary Material



Publication History

Received: 28 February 2020

Accepted: 25 August 2020

Article published online:
08 October 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Adam MP, Polifka JE, Friedman JM. Evolving knowledge of the teratogenicity of medications in human pregnancy. Am J Med Genet C Semin Med Genet 2011; 157C (03) 175-182
    CrossrefPubMedGoogle Scholar
  • 2 Lynch MM, Squiers LB, Kosa KM. et al. Making decisions about medication use during pregnancy: implications for communication strategies. Matern Child Health J 2018; 22 (01) 92-100
    CrossrefPubMedGoogle Scholar
  • 3 Feghali M, Venkataramanan R, Caritis S. Pharmacokinetics of drugs in pregnancy. Semin Perinatol 2015; 39 (07) 512-519
    CrossrefPubMedGoogle Scholar
  • 4 Branum AM, Bailey R, Singer BJ. Dietary supplement use and folate status during pregnancy in the United States. J Nutr 2013; 143 (04) 486-492
    CrossrefPubMedGoogle Scholar
  • 5 Lee E, Maneno MK, Smith L. et al. National patterns of medication use during pregnancy. Pharmacoepidemiol Drug Saf 2006; 15 (08) 537-545
    CrossrefPubMedGoogle Scholar
  • 6 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 (01) 51.e1-51.e8
    CrossrefPubMedGoogle Scholar
  • 7 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): 771-777
    CrossrefPubMedGoogle Scholar
  • 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 (03) 465-473
    CrossrefPubMedGoogle Scholar
  • 9 Thorpe PG, Gilboa SM, Hernandez-Diaz S. et al; National Birth Defects Prevention Study. Medications in the first trimester of pregnancy: most common exposures and critical gaps in understanding fetal risk. Pharmacoepidemiol Drug Saf 2013; 22 (09) 1013-1018
    CrossrefPubMedGoogle Scholar
  • 10 Haas DM, Marsh DJ, Dang DT. et al. Prescription and other medication use in pregnancy. Obstet Gynecol 2018; 131 (05) 789-798
    CrossrefPubMedGoogle Scholar
  • 11 Sullivan KM, Ford ES, Azrak MF, Mokdad AH. Multivitamin use in pregnant and nonpregnant women: results from the behavioral risk factor surveillance system. Public Health Rep 2009; 124 (03) 384-390
    CrossrefPubMedGoogle Scholar
  • 12 Riley EH, Fuentes-Afflick E, Jackson RA. et al. Correlates of prescription drug use during pregnancy. J Womens Health (Larchmt) 2005; 14 (05) 401-409
    CrossrefPubMedGoogle Scholar
  • 13 Buitendijk S, Bracken MB. Medication in early pregnancy: prevalence of use and relationship to maternal characteristics. Am J Obstet Gynecol 1991; 165 (01) 33-40
    CrossrefPubMedGoogle Scholar
  • 14 Grobman WA, Parker CB, Willinger M. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) Network*. Racial disparities in adverse pregnancy outcomes and psychosocial stress. Obstet Gynecol 2018; 131 (02) 328-335
    CrossrefPubMedGoogle Scholar
  • 15 Burris HH, Mitchell AA, Werler MM. Periconceptional multivitamin use and infant birth weight disparities. Ann Epidemiol 2010; 20 (03) 233-240
    CrossrefPubMedGoogle Scholar
  • 16 Hasan R, Olshan AF, Herring AH, Savitz DA, Siega-Riz AM, Hartmann KE. Self-reported vitamin supplementation in early pregnancy and risk of miscarriage. Am J Epidemiol 2009; 169 (11) 1312-1318
    CrossrefPubMedGoogle Scholar
  • 17 Robbins C, Boulet SL, Morgan I. et al. Disparities in preconception health indicators - behavioral risk factor surveillance system, 2013-2015, and pregnancy risk assessment monitoring system, 2013-2014. MMWR Surveill Summ 2018; 67 (01) 1-16
    CrossrefPubMedGoogle Scholar
  • 18 Johnston EO, Sharma AJ, Abe K. Association between maternal multivitamin use and preterm birth in 24 states, pregnancy risk assessment monitoring system, 2009-2010. Matern Child Health J 2016; 20 (09) 1825-1834
    CrossrefPubMedGoogle Scholar
  • 19 Jasti S, Siega-Riz AM, Cogswell ME, Hartzema AG, Bentley ME. Pill count adherence to prenatal multivitamin/mineral supplement use among low-income women. J Nutr 2005; 135 (05) 1093-1101
    CrossrefPubMedGoogle Scholar
  • 20 Buck Louis GM, Grewal J, Albert PS. et al. Racial/ethnic standards for fetal growth: the NICHD fetal growth studies. Am J Obstet Gynecol 2015; 213 (04) 449.e1-449.e41
    CrossrefPubMedGoogle Scholar
  • 21 Grewal J, Grantz KL, Zhang C. et al. Cohort profile: NICHD fetal growth studies-singletons and twins. Int J Epidemiol 2018; 47 (01) 25-25l
    CrossrefPubMedGoogle Scholar
  • 22 Kelley KE, Kelley TP, Kaufman DW, Mitchell AA. The slone drug dictionary: a research driven pharmacoepidemiology tool. Pharmacoepidemiol Drug Saf 2003; 12 (S1): 168-169
    PubMedGoogle Scholar
  • 23 Hall SA, Chiu GR, Kaufman DW. et al. General exposures to prescription medications by race/ethnicity in a population-based sample: results from the Boston Area Community Health Survey. Pharmacoepidemiol Drug Saf 2010; 19 (04) 384-392
    CrossrefPubMedGoogle Scholar
  • 24 Broussard CS, Rasmussen SA, Reefhuis J. et al; National Birth Defects Prevention Study. Maternal treatment with opioid analgesics and risk for birth defects. Am J Obstet Gynecol 2011; 204 (04) 314.e1-314.e11
    CrossrefPubMedGoogle Scholar
  • 25 Benedum CM, Yazdy MM, Mitchell AA, Werler MM. Impact of periconceptional use of nitrosatable drugs on the risk of neural tube defects. Am J Epidemiol 2015; 182 (08) 675-684
    CrossrefPubMedGoogle Scholar
  • 26 Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004; 159 (07) 702-706
    CrossrefPubMedGoogle Scholar
  • 27 Lupattelli A, Spigset O, Twigg MJ. et al. Medication use in pregnancy: a cross-sectional, multinational web-based study. BMJ Open 2014; 4 (02) e004365
    CrossrefPubMedGoogle Scholar
  • 28 Refuerzo JS, Blackwell SC, Sokol RJ. et al. Use of over-the-counter medications and herbal remedies in pregnancy. Am J Perinatol 2005; 22 (06) 321-324
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Tinker SC, Broussard CS, Frey MT, Gilboa SM. Prevalence of prescription medication use among non-pregnant women of childbearing age and pregnant women in the United States: NHANES, 1999-2006. Matern Child Health J 2015; 19 (05) 1097-1106
    CrossrefPubMedGoogle Scholar
  • 30 Horne R, Graupner L, Frost S, Weinman J, Wright SM, Hankins M. Medicine in a multi-cultural society: the effect of cultural background on beliefs about medications. Soc Sci Med 2004; 59 (06) 1307-1313
    CrossrefPubMedGoogle Scholar
  • 31 Bussey-Jones J, Genao I. Impact of culture on health care. J Natl Med Assoc 2003; 95 (08) 732-735
    PubMedGoogle Scholar
  • 32 Admon LK, Winkelman TNA, Moniz MH, Davis MM, Heisler M, Dalton VK. Disparities in chronic conditions among women hospitalized for delivery in the United States, 2005-2014. Obstet Gynecol 2017; 130 (06) 1319-1326
    CrossrefPubMedGoogle Scholar
  • 33 Thomas SH, Yates LM. Prescribing without evidence - pregnancy. Br J Clin Pharmacol 2012; 74 (04) 691-697
    CrossrefPubMedGoogle Scholar
  • 34 Navaro M, Vezzosi L, Santagati G, Angelillo IF. Collaborative Working Group. Knowledge, attitudes, and practice regarding medication use in pregnant women in Southern Italy. PLoS One 2018; 13 (06) e0198618
    CrossrefPubMedGoogle Scholar
  • 35 Withers M, Kharazmi N, Lim E. Traditional beliefs and practices in pregnancy, childbirth and postpartum: a review of the evidence from Asian countries. Midwifery 2018; 56: 158-170
    CrossrefPubMedGoogle Scholar
  • 36 Kaeser L. Task force on research specific to pregnant women and lactating women. Accessed September 2018 at: https://www.nichd.nih.gov/sites/default/files/2018-09/PRGLAC_Report.pdf
    PubMedGoogle Scholar
  • 37 Pariente G, Leibson T, Carls A, Adams-Webber T, Ito S, Koren G. Pregnancy-associated changes in pharmacokinetics: a systematic review. PLoS Med 2016; 13 (11) e1002160
    CrossrefPubMedGoogle Scholar
  • 38 Benevent J, Montastruc F, Damase-Michel C. The importance of pharmacoepidemiology in pregnancy-implications for safety. Expert Opin Drug Saf 2017; 16 (10) 1181-1190
    CrossrefPubMedGoogle Scholar
  • 39 Lacroix I, Damase-Michel C, Lapeyre-Mestre M, Montastruc JL. Prescription of drugs during pregnancy in France. Lancet 2000; 356 (9243): 1735-1736
    CrossrefPubMedGoogle Scholar
  • 40 van Gelder MM, van Rooij IA, de Walle HE, Roeleveld N, Bakker MK. Maternal recall of prescription medication use during pregnancy using a paper-based questionnaire: a validation study in the Netherlands. Drug Saf 2013; 36 (01) 43-54
    CrossrefPubMedGoogle Scholar
  • 41 Alegría M, Chatterji P, Wells K. et al. Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatr Serv 2008; 59 (11) 1264-1272
    CrossrefPubMedGoogle Scholar
  • 42 Yamamoto A, McCormick MC, Burris HH. Disparities in antidepressant use in pregnancy. J Perinatol 2015; 35 (04) 246-251
    CrossrefPubMedGoogle Scholar