Prescription and Other Medication Use in Pregnancy.

OBJECTIVE: To characterize prescription and other medication use in a geographically and ethnically diverse cohort of women in their first pregnancy. METHODS: In a prospective, longitudinal cohort study of nulliparous women followed through pregnancy from the first trimester, medication use was chronicled longitudinally throughout pregnancy. Structured questions and aids were used to capture all medications taken as well as reasons they were taken. Total counts of all medications taken including number in each category and class were captured. Additionally, reasons the medications were taken were recorded. Trends in medications taken across pregnancy and in the first trimester were determined. RESULTS: Of the 9,546 study participants, 9,272 (97.1%) women took at least one medication during pregnancy with 9,139 (95.7%) taking a medication in the first trimester. Polypharmacy, defined as taking at least five medications, occurred in 2,915 (30.5%) women. Excluding vitamins, supplements, and vaccines, 73.4% of women took a medication during pregnancy with 55.1% taking one in the first trimester. The categories of drugs taken in pregnancy and in the first trimester include the following: gastrointestinal or antiemetic agents (34.3%, 19.5%), antibiotics (25.5%, 12.6%), and analgesics (23.7%, 15.6%, which includes 3.6%; 1.4% taking an opioid pain medication). CONCLUSION: In this geographically and ethnically diverse cohort of nulliparous pregnant women, medication use was nearly universal and polypharmacy was common. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01322529.

Prevention and treatment of osteoporosis in primary care offices.

OBJECTIVES: To examine the use of medications for prevention and treatment of osteoporosis and testing for osteoporosis for postmenopausal women in primary care offices. METHOD: This cross-sectional survey study uses electronic medical records data over a 1-year period (January-December 2000) of women >/=55 years of age, either with (n = 31) or without (n = 782) a diagnosis of osteoporosis, who were active patients of two family practice and three gynecology offices in Delaware (n = 813). It presents documented use of medications for prevention or treatment of osteoporosis (estrogens, bisphosphonates, raloxifene, calcitonin, or calcium) and receipt of bone mineral density (BMD) testing. RESULTS: Of women without osteoporosis, 27.4% were taking prescription osteoporosis-related medications, and 32.9% were taking prescription medications or calcium supplements or both. Women were less likely to be taking these medications if they were >70 years of age (adjusted odds ratio [OR] = 0.42, p < 0.01) or were patients of gynecologists (adjusted OR = 0.48, p < 0.01). They were not more likely to take medications if they had risk factors for osteoporosis. Of women with osteoporosis, 58.1% were taking prescription osteoporosis-related medications, and 61.3% were taking prescription medications or calcium or both. BMD testing was done for 34% of all women and was not more likely for those with risk factors. CONCLUSIONS: In family medicine and gynecology offices, most postmenopausal women do not take preventive medications or get testing for osteoporosis. Even among those with known osteoporosis, many do not take medications for treatment of their osteoporosis.