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Use of high-risk medications by pregnant women is not uncommon

Many pregnant women require medications to manage previously diagnosed conditions such as asthma and hypertension or to treat pregnancy-induced conditions. For example, a 2-year survey found that during half of outpatient visits, pregnant women were prescribed one or more medications (54 percent of hospital outpatient clinic visits and 44 percent of visits to private physician offices).

The majority of medications prescribed were from drug classes not considered risky during pregnancy by the U.S. Food and Drug Administration (FDA). However, prescriptions for FDA Class D or X medications, which can harm the fetus when given to pregnant women, accounted for 6.4 percent and 2.9 percent of visits to private physicians and hospital clinics, respectively.

Category D drugs include progesterone, tetracycline, aspirin, cortisone, tretinoin (Retin-A), and lithium. Category X drugs include oral contraceptives and estrogens as well as medroxyprogesterone, simvastatin, trazolam, and warfarin. The survey also revealed that in 1 of every 10 private physician visits, a pregnant women received a drug with unknown pregnancy risk. Sixty percent of drugs in the Physician's Desk Reference have not been assigned FDA pregnancy categories, note the researchers.

Drug prescriptions for pregnant women also varied by regions. Clinic and physician office visits in the Midwest were less likely to be associated with high-risk drugs compared with the Northeast. However, women who visited hospital clinics in the West were nearly twice as likely to be prescribed category D or X drugs than in other regions, while those from the South were 70 percent less likely.

These findings agree with reports from other studies on the prevalent use of medication and exposure to higher risk medications during pregnancy. They were based on analysis of outpatient visits by pregnant women during 1999 and 2000 detailed in the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. The study was supported by the Agency for Healthcare Research and Quality (HS11673).

More details are in "National patterns of medication use during pregnancy," by Euni Lee, Pharm.D., Ph.D., Mary K. Maneno, B.S., Leah Smith, Pharm.D., and others, in the August 2006 Pharmacoepidemiology and Drug Safety 15, pp. 537-545.

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