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DTB 51:61 doi:10.1136/dtb.2013.6.0182
  • Article

Prescribing in pregnancy—therapeutic discrimination?

It is estimated that 10% of pregnant women have a chronic medical disorder that requires regular use of medicines. In addition, some women develop health problems during pregnancy, and at least 40% take a prescription drug at some point.1,2 The impact of the increasing age and body mass index of the population has contributed to the proportion of women who require medication during pregnancy. For example, 4% of women delivering in England and Wales in 2011 were aged 40 years or over (compared with 1% in the 1990s) and 19% of women of child-bearing age in England in 2008 were obese.3,4 The relative lack of information on the use of medicines during pregnancy remains an area of concern for healthcare professionals.

Indirect maternal deaths in the UK, where a new or pre-existing medical or mental health problem is aggravated by pregnancy, have almost doubled in the last 20 years and exceed direct maternal deaths by 50%.5 The leading causes include cardiac conditions, neurological disorders, sepsis, thromboembolism and mental health problems. Yet it is clear that prescribing of, and adherence to, medication in pregnancy can be poor; many patients being wary of taking medicines when there is so little published evidence on the risks and benefits. Doctors are afraid of causing harm and the spectre of thalidomide-induced phocomelia continues to haunt healthcare professionals.6 The summary of product characteristics often advises that a drug should be used only if the benefits outweigh the risks, even though the risks may not have been properly identified. Drug companies and researchers generally exclude pregnant women from trials even when the medication is likely to be used by women of childbearing age. Trials aimed specifically at pregnant women in whom physiological changes, placental transfer kinetics and foetal exposure …

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