الفهرس 
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Abstract
During pregnancy, a series of physiological changes occur that affect pharmacokinetics and pharmacodynamics of medications and therefore impact drug dosing and effect. There have numerous epidemiological studies that have attempted to evaluate the prevalence of medication use in pregnancy.
Medications use either prescribed or non-prescribed is common worldwide, some of these medications have unproven safety and may adversely affect the fetus. More than 10% of birth defects resulted from the mothers’ exposure to drugs. Therefore medicine consumption, self-medication and lack of knowledge about the correct use of drugs represent additional problems.
The aim of the study was to develop a model for the determinants of medication use during pregnancy in Kafr Al-Sheikh city, Egypt. The specific objectives were to describe the pattern of use of different medications during pregnancy, to assess the perception of pregnant women regarding medications use and to determine the determinants of medication use during pregnancy among pregnant women attending family health care clinics in Kafr Al-Sheikh city.
A cross-sectional study was conducted to collect data about socio-demographic characteristics of the sample, obstetrics and pregnancy related information, medical history of the study women, medications use during current pregnancy, general perception towards medications use during pregnancy and sources of information about medications use.
Data entry and statistical analysis were done using SPSS version 25.0 software program, two-tailed tests were used for the whole analysis and alpha error 0.05.
The study revealed the following main results:
1. There was a high prevalence of medication use during pregnancy of 87.8%.
2. Out of 400 pregnant women, the prevalence of supplement intake was 84.5% with mean number of 3.2, followed by prescribed medications use 54.8% with mean number of 3.1 and 17.8% had used non-prescribed medications during current pregnancy with mean number of 2.2.
3. A reduction in the frequency of PM use across pregnancy trimesters was demonstrated from 53.0% in the first trimester to 24.3% and 22.7% in the second and third trimesters, respectively. In contrast, there was a variation of NPM use across pregnancy trimesters where 49.7% were in the first trimester, 20.9 and 29.4% in the second and third trimesters, respectively.
4. As regards medical conditions of the pregnant women, 75.5% of them experienced acute conditions and 19.0% had chronic conditions. About one third of acute or short term conditions occurred in the first and third trimesters (30.2% and 30.1%,
respectively), followed by 26.8% in the second trimester. Only 12.9% occurred through the all trimesters of pregnancy.
5. Regarding the use of medications according to the most common medical conditions among studied sample, medications for obstetrics disorders constituted 40.9% of all medications used, followed by medications for GIT disorders (18.4%), medications for respiratory conditions (10.2%), medications for hypertension (7.1%), medications for UTIs (6.6%), medications for diabetes (2.6%) and medications for thyroid disorders (1.1%). Other medications (analgesics) were also used in proportion of 13.1%.
6. As regards medications safety categories, 60% of PM used during pregnancy were from category B, followed by 30% from category C, 6.3% from category D and 3.2% from category A. For NPM, 41.8% of medications were from category C followed by 34.7% from category B and 23.5% from category D.
7. The majority of the study women (84.5%) took supplements during pregnancy, supplements taken constituted 56.4% out of total medications taken by the study women, including iron, calcium, folic acid, vitamin B12, omega 3 and vitamin C (40.9%, 25.2%, 19.8%, 8.9%, 2.9% and 2.3%, respectively). The overall intake of supplements differed across the pregnancy trimesters where 31.9% used during the first trimester, 39.0% and 29.1% in the second and third trimesters, respectively.
8. Less than half (43.8%) of the study women had poor perception about drug utilization during pregnancy, followed by 30.7% who had fair perception and 25.5% had good perception about medications use during pregnancy.
9. The main sources of information about medication use during pregnancy were physicians (63.8%), followed by pharmacists (37%) and internet (33.8%).
10. This study showed the independent variables that affect non-prescribed medication use during pregnancy as follows:
- The pregnant women aged 25 years or above were more liable to use NPM relative to younger women (p < 0.05).
- Regarding residence, there was a significant increase of NPM in urban areas (OR= 3.35, p< 0.001).
- Pregnant women with high educational level were more likely for NPM intake (OR= 4.5, p<0.001), while employed women weren’t significantly differed from unemployed ones regarding use of NPM during pregnancy (p> 0.05).
- Concerning gestational age, pregnant women who in the third trimester were more likely to use NPM during pregnancy (OR= 11.24, p< 0.001).
- Multi-gravida (OR= 2.406, p= 0.041) or multi-para (OR= 2.5, p= 0.02) was an independent variables that significantly associated with NPM use during pregnancy, while history of abortion wasn’t significant (p> 0.05).
- In addition, having a child with congenital anomalies increases the probability of using of NPM (OR= 2.5, p= 0.006).
- Regarding medical condition of the respondent, presence of acute or chronic health problems wasn’t associated with NPM use during pregnancy (p> 0.05).
- Adequate level of perception about medications decreases the probability of NPM use during pregnancy (OR= 0.302, p= 0.001).
- As regards sources of information, pharmacists, internet as a source of information, and reading the medications’ leaflet increase the probability of using NPM during pregnancy (OR= 3.526, p< 0.001), (OR= 3.675, p< 0.001) and (OR= 2.241, p= 0.004) respectively, while physicians provide information about medication decrease the probability (OR= 0.331, p< 0.001).
The multivariate logistic regression analysis was adopted to determine the significant variables for NPM use during pregnancy, which were parity, gestational age, level of perception, internet as a source of information and when the physician doesn’t provide information about medications.
Conclusion:
Based on the results of the current study, the following can be concluded:
1. The prevalence of medications use during pregnancy was high in the present study reflecting low level of awareness regarding risks of medications use.
2. The highest frequency of medications use was observed in the first trimester, which is considered the most critical stage of pregnancy.
3. The perception about medication use was mostly inadequate.
4. Multi-parity and gestational age are variables that increase the probability of using NPM during pregnancy.
5. The better the perception about medications, the less the probability of using medications without prescription during pregnancy.
6. When the physician provides information about the potential risk of medications use decreases the use of NPM during pregnancy, while depending on internet as a source of information increases the risk of NPM use.
Recommendations:
Based on the results of the current study, the main recommendations are:
1. Provision of medications list including medications that it is safe for use during pregnancy.
2. Avoidance of medications use during pregnancy unless necessary and prescribed by the physician.
3. National drug authority should provide regulation policies on medications use at drug dispensing points to protect the pregnant women.
4. Implementing a general health education program about benefits and harms of medications when used during pregnancy in family healthcare centers.
5. Pharmacists should play a role in raising the awareness about the potential risks of medications if given during pregnancy.
6. Following a dietary therapy and healthy lifestyle to control chronic diseases as diabetes or hypertension is a preferable choice to reduce the intake of medications and the accompanied side effects during pregnancy.
7. Physicians should educate pregnant women how to control common symptoms developed due to pregnancy as nausea or vomiting to reduce further complications and number of medications used.