Drug exposure during pregnancy; Is there a room for improvement in a secondary hospital in Pakistan?

INTRODUCTION: For a better promotion of the rational use of drugs during pregnancy, it is important to assess the drug utilization pattern during pregnancy to see at what extent there is a scope for improvement· Little is known about prescribing during pregnancy in developing countries such as Pakistan· The study aims to assess the recent prescribing practice in pregnant women in a secondary hospital in Pakistan·

 METHODS: The study is a cross-sectional descriptive design· The prescription issued to pregnant women at obstetrics department in a secondary healthcare facility in north-east Pakistan, were collected· All medicines prescribed to pregnant women that attended the study hospital during March 2013 were analyzed , and classified according to FDA , and Swedish pregnancy categorisation of drugs·

RESULTS:  The present study describes 1,550 prescriptions collected from 404 pregnant women· Most of the ante-natal prescriptions were issued during first (38·2%), and second (37·9%) trimesters of pregnancy as compared to third trimester (23·2%)· An average of 2·5 ± 1·330 (range 0 – 6) drugs were prescribed per prescription· In current study, all the pregnant women visiting the antenatal clinic received folic acid, and iron supplementation. No women received a FDA category X (exclusively contraindicated) drug, whereas 0·6 % (n=23) of the prescribed drugs are included in FDA fetal risk category D, and 4·3% (n=167) in category C. Acetylsalicylic acid was the only FDA category D prescribed drug whereas most FDA category C prescribed medicines were clotrimazole (n=80; 47·9% of the group), and dydrogesterone (n=63; 37·7%).

CONCLUSIONS: Extensive provision of iron and folic acid suplimentation to all women and no exposure to teratogenic drugs are indicative of good clinical practise. Prescription of safer ulternatives for FDA category C and D drugs would further improve the priscribing practise in the facility.