Prenatal medication use in a prospective pregnancy cohort by pre-pregnancy obesity status

• Published in: The journal of maternal-fetal & neonatal medicine 2022-12, Vol.35 (25), p.5799-5806
• Main Authors: Vafai, Yassaman, Yeung, Edwina H., Sundaram, Rajeshwari, Smarr, Melissa M., Gerlanc, Nicole, Grobman, William A., Skupski, Daniel, Chien, Edward K., Hinkle, Stefanie N., Newman, Roger B., Wing, Deborah A., Ranzini, Angela C., Sciscione, Anthony, Grewal, Jagteshwar, Zhang, Cuilin, Grantz, Katherine L.
• Format: Article
• Language: English
• Subjects: Body Mass Index; Diabetes, Gestational - drug therapy; Diabetes, Gestational - epidemiology; Female; Humans; medication classes; medication use; Obesity - complications; Obesity - epidemiology; Pre-pregnancy obesity; Pregnancy; pregnant women; prenatal medication; Progesterone; Prospective Studies
• ISSN: 1476-7058; 1476-4954
• DOI: 10.1080/14767058.2021.1893296

The association between obesity (body mass index (BMI) ≥ 30 kg/m 2 ) and pattern of medication use during pregnancy in the United States is not well-studied. Higher pre-pregnancy BMI may be associated with increases or decreases in medication use across pregnancy as symptoms (e.g. reflux) or comorbidities (e.g. gestational diabetes) requiring treatment that may be associated with higher BMI could also change with advancing gestation. To determine whether prenatal medication use, by the number and types of medications, varies by pre-pregnancy obesity status. In a secondary data analysis of a racially/ethnically diverse prospective cohort of pregnant women with low risk for fetal abnormalities enrolled in the first trimester of pregnancy and followed to delivery (singleton, 12 United States clinical sites), free text medication data were obtained at enrollment and up to five follow-up visits and abstracted from medical records at delivery. In 436 women with obesity and 1750 women without obesity (pre-pregnancy BMI, 19-29.9 kg/m 2 ), more than 70% of pregnant women (77% of women with and 73% of women without obesity) reported taking at least one medication during pregnancy, respectively (adjusted risk ratio (aRR)=1.10, 95% confidence interval (CI)=1.01, 1.20), with 81% reporting two and 69% reporting three or more. A total of 17 classes of medications were identified. Among medication classes consumed by at least 5% of all women, the only class that differed between women with and without obesity was hormones and synthetic substitutes (including steroids, progesterone, diabetes, and thyroid medications) in which women with obesity took more medications (11 vs. 5%, aRR = 1.9, 95% CI = 1.38, 2.61) compared to women without obesity. Within this class, a higher percentage of women with obesity took diabetes medications (2.3 vs. 0.7%) and progesterone (3.4 vs. 1.3%) than their non-obese counterparts. Similar percentages of women with and without obesity reported consuming medications in the remaining medication classes including central nervous system agents (50 and 46%), gastrointestinal drugs (43 and 40%), anti-infective agents (23 and 21%), antihistamines (20 and 17%), autonomic drugs (10 and 9%), and respiratory tract agents (7 and 6%), respectively (p > 0.05 for all adjusted comparisons). There were no differences in medication use by obesity status across gestation. Since the study exclusion criteria limited the non-obese group to women without thyroid disea