Drug utilization patterns in pregnant women: a case study at the Mount Hope Women's Hospital in Trinidad, West Indies

OBJECTIVE: To explore drug (prescription, over-the-counter and herbal) utilization in pregnant women attending a public sector tertiary healthcare institution. METHODS: This was a cross-sectional case study in women attending antenatal clinics at the Mount Hope Women's Hospital. Women (506) who consecutively presented for routine care at the antenatal clinic were interviewed on the medication they took. Descriptive statistics and logistic regression for predictors of drug use were done using SPSS 16. RESULTS: There were 200 (39.5%) primigravidae, 306 (60.5%) multigravidae and 299 (59%) women were in the third trimester of pregnancy. Most women (69.8%) were between 20-35 years of age. Women took an average of 1.32, 1.22 and 0.94 prescribed drugs in each trimester, respectively. Multivitamins (59.8%) and iron/folic acid (54.2%) were the most frequently prescribed drugs. Regardless of trimester, only 20% of women took supplemental calcium. Very few women (2.4%) took herbal medications. Paracetamol was the most common over-the-counter (OTC) medication in all trimesters. Women with secondary level education were most likely to use OTC iron/folic acid (p = 0.02), paracetamol and histamine2 receptor antagonists [H2RAs] (p = 0.001). More primigravidae took non-steroidal anti-inflammatory drugs (p = 0.02) and more women in the first trimester used antiemetics (p = 0.001). Age group (p = 0.048), marital status (p = 0.001) and the trimester of pregnancy (p = 0.001) were predictors of drug utilization. CONCLUSION: Overall, women in tertiary healthcare institutions took medication as prescribed particularly multivitamins and iron/folic acid. More women with higher education took OTC paracetamol, iron/folic acid and vitamin supplements. Herbal supplements were rarely used. Research on drug utilization in primary care facilities is recommended. OBJETIVO: Explorar el uso de los medicamentos (con prescripcion, sin receta medica, herbarios) en mujeres embarazadas que asisten a una institucion terciaria de atencion a la salud publica dentro del sector publico. METODOS: Se trato de un estudio transversal de mujeres que asisten a las clinicas prenatales en el Hospital de Mujeres Mount Hope. Las mujeres (506) que consecutivamente se presentaron para cuidados de rutina en la clinica prenatal, fueron entrevistadas acerca de la medicacion que tomaban. Se hicieron estadisticas descriptivas y se hizo una regresion logistica para los predictores del uso del medicamento usando SPSS 16. RESULTADOS: Habia 200 (39.5%) primerizas, 306 (60.5%) multiparas, y 299 (59%) embarazadas en su tercer trimestre. La mayoria de las mujeres (69.8%) tenian entre 20-35 anos de edad. Las mujeres tomaban un promedio de 1.32, 1.22 y 0.94 medicamentos prescritos en cada trimestre, respectivamente. Las multivitaminas (59.8%) y el hierro/acido folico (54.2%) fueron los medicamentos mas frecuentemente prescritos. Con independencia del trimestre, solo 20% de las mujeres tomaron suplemento de calcio. Muy pocas mujeres (2.4%) tomaban medicaciones herbarias. El paracetamol fue el medicamento sin receta mas comun en todos los trimestres. Las mujeres con nivel de educacion secundaria presentaban una mayor probabilidad de usar hierro/acido folico (p = 0.02), el paracetamol y los antagonistas de los receptores de la histamina-2- [H2RAs] (p = 0.001). Un mayor numero de primerizas tomaron medicamentos anti-inflamatorios no esteroideos (p = 0.02) y mas mujeres en el primer trimestre usaron anti-emeticos (p = 0.001). El grupo etario (p = 0.048), el estado matrimonial (p = 0.001) y el trimestre de embarazo (p = 0.001) fueron predictores de la utilizacion de medicamentos. CONCLUSION: En general, las mujeres en las instituciones terciarias de atencion a la salud tomaron la medicacion como fue prescrita, en particular las multivitaminas y el hierro/acido folico. Mas mujeres con mayor escolaridad tomaron medicamentos sin recetas: paracetamol, hierro/acido folico y suplementos de vitamina. Raramente se usaron suplementos herbarios. Se recomienda la investigacion del uso de medicamentos en centros de atencion primaria.