The Status Of Medication Use And Follow-up Study Of Pregnancy Outcomes In Pregnant Women Consulted On Drugs

Objectives: Medication safety during pregnancy is essential for both mothers and infants.But most drugs lack safety data for use during pregnancy.The purpose of this study was to investigate the current status of medication use and drug safety in pregnant women consulted on drugs,then follow up their pregnancy outcomes and neonatal conditions after medication to clarify the correlation between medication and adverse pregnancy outcomes or abnormal neonatal conditions.Finally,to provide more research evidence that can promote the safe use of drugs during pregnancy.Methods: From January 2017 to December 2018,the pregnant women in the outpatient department of Sichuan Provincial People’s Hospital for pregnancy medication consultation was taken as the study population.And the pregnant women were followed up by the “pregnancy medication consultation data management system” for detailed registration inclusion and ongoing follow-up.On the basis of the registration follow-up,the medication use profile and drug safety of the study population were first evaluated,and the univariate analysis and multivariate logistic regression analysis were performed on the population using high-risk drugs(D or X drugs)to explore the possible factors affecting the use of high-risk drugs in pregnant women,then analyzing the pregnancy outcomes and neonatal follow-up results of the study population,and discussing the effects of age,pregnancy history,number of drugs used,risk level of drug use and duration of drug use on pregnancy outcomes and neonatal conditions.Finally,ribavirin was used as a specific research drug to analyze the correlation between drug exposure during pregnancy and adverse pregnancy outcomes or birth defects,providing more information on the safety of ribavirin during pregnancy.Results: A total of 635 pregnant women were included in the observation period,and 567 cases were followed up,the loss rate was 10.71%.More than 70% of the study population used drugs under unknown pregnancy conditions,3 drugs per capita,and more than 90% of the medications were used in the early pregnancy(<12 weeks).The three types of drugs with the highest utilization rate are Chinese patent medicine,antibacterial drugs and anti-allergic drugs.Among the drugs used in the study population,class B and class C drugs had the largest number of types and the highest utilization rate,and about 35% of pregnant women had at least one class D or X drug exposure.The most commonly used class X drug was ribavirin.Univariate analysis showed that patients with multiple pregnancies were more likely to use high-risk drugs than those with primary pregnancies,and those with a history of adverse pregnancy were more likely to use high-risk drugs than those without a history of adverse pregnancy.Patients with gestational age ≤12 weeks were more likely to use high-risk drugs than those with gestational age >12 weeks,the difference was statistically significant(P<0.05).Multivariate logistic regression showed that,the probability of using high-risk drugs in people with gestational age ≤ 12 weeks is greater than that of gestational age > 12 weeks 2.25 times(95% confidence interval 1.29-3.91).The live birth rate,spontaneous abortion rate,selective termination pregnancy rate and premature delivery rate were 81.66%,7.76%,4.94% and 9.05% respectively.Univariate analysis of different pregnancy outcomes and neonatal conditions showed that drug risk levels had an impact on pregnancy outcomes and neonatal birth weight.Compared with other grades,the class X drug users had lower live birth rate,higher spontaneous abortion rate and higher rate of low birth weight infants,the class D and class X drug users had a higher rate of selective termination of pregnancy.In addition,compared with unexposed population,the risk of spontaneous abortion in people exposed to ribavirin during pregnancy can be increased by more than 2 times,the risk of selective termination of pregnancy can be increased by more than 7 times,and the risk of low birth weight infants can be increased by more than 6 times.However,the risk of birth defects has not increased.Conclusions: A large number of women have used high-risk drugs(class D or X drugs)during pregnancy,and most of the drugs were accidental exposure during the first trimester of pregnancy(≤ 12 weeks),while the use of high-risk drugs was associated with adverse pregnancy outcomes and low birth weight of newborns.Therefore,awareness of drug use among women of childbearing age should be strengthened to reduce accidental drug exposure during pregnancy.At the same time,pregnant women who use high-risk drugs should be continuously monitored and followed up to collect more safety information on the use of high-risk drugs during pregnancy.It is of great significance to promote the safe and rational use of drugs during pregnancy.