Pharmacotherapy in Pregnancy or Puerperium and the Management of Gestational Diabetes Mellitus, Hypertensive Diseases and Non-serious infections in Maternity.

摘要

Background Medication use during pregnancy and the puerperium can be risky given the increased potential for harm to the baby in utero and during lactation. Despite these risks, the use of therapy can reduce negative outcomes from maternal illnesses. Unfortunately, guidance on safe pharmacotherapy in pregnancy is unavailable and scarce data on national prescribing trends exists. Limited information on the impact and management of several common maternal illnesses is also concerning. More specifically, few studies have examined the volume and type of health care utilization from gestational diabetes mellitus (GDM) and maternal hypertensive diseases (HD) or assessed the management of non-serious infections during pregnancy.;Methods The main objective of this study was to evaluate pharmacotherapy in pregnancy and puerperium and to assess the management of GDM, HD in pregnancy and non-serious infection in maternity. To achieve this objective, a cross-sectional study using the Medical Expenditure Panel Survey (MEPS) was conducted. The main outcomes were the use of higher FDA pregnancy risk category drugs (C, D or X), the volume of health care utilization associated with GDM, and HD in pregnancy, the use of anti-infective therapy and the occurrence of non-serious infections during maternity. Bivariate analysis was done using student t-tests and chi-square tests. To examine the predictive factors of using risk category C, D, or X therapy, and volume of health care utilization multivariable logistic and Poisson regression models were used respectively.;Results Data from 5,265 mothers was used in this study. Majority of the women were under 35 years (>80%), had normal pregnancies (82%), were White (77.8%), and had only private insurance (51.6%).The overall findings indicated increasing pharmacotherapy in pregnancy and a high prevalence of risk category C, D, or X therapy.(~50%). Their prescribing was less associated with normal pregnancies (p<0.05), and more associated with care in the ambulatory care setting and by psychiatrists. There was increased health care utilization by women with GDM, diabetes mellitus and HD in pregnancy. Urinary tract conditions were the most common non-serious infections were also Predominant maternal care for non-serious infections was for urinary tract infections and took place in office-based provider settings. Limited, albeit risky, use of sulfamethoxazole/trimethoprim was observed (2%).;Conclusion The high prevalence of high risk category medications underscores the need for more guidance on the use of therapy during gestation and puerperium. Preventive strategies such as pre-conception care models need to be emphasized to reduce the burden of GDM, Diabetes, and HD in the future. More data on the use of anti-infective agents beyond the clinical setting needs to be generated.