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Women’s health at risk from reluctance to prescribe medicine during pregnancy

1 March 2023

Research has found that a reluctance among healthcare professionals to prescribe and dispense medications to women who are pregnant is placing their health at risk.

The study conducted by researchers at the British Pregnancy Advisory Service, Cardiff University, Pregnancy Sickness Support, and University College London, found that while prescribers need to balance maternal benefit with potential foetal harm when prescribing in pregnancy, women’s individual circumstances were not always considered, and they were not fully engaged in decision making.

The study analysed 7090 women and interviewed 34 women who were pregnant or had been pregnant in the last five years. The team found many examples where health professionals used fear of foetal harm to justify a refusal to prescribe or dispense otherwise recommended medications. This had a significant impact not only on women’s health, but on their emotional wellbeing.

Professor Julia Sanders, Cardiff University’s School of Healthcare Sciences, said: “During the study we heard from many pregnant women who were not getting the medications they needed. This particularly related to medicines for severe sickness, pregnancy pain and mental health conditions.

“Some women were blocked from getting recommended medicines because doctors would not prescribe them or pharmacists would not dispense them. Other women were prescribed medicines, but a lack of information meant they lacked confidence to take them. This study suggests we all need to work harder to ensure pregnant women are able to access the right medicines for themselves and their baby.”

There are national prescribing guidelines for treatment during pregnancy. Whilst some medications, such as thalidomide or isotretinoin, should not be used, most other medications are safe and widely used during pregnancy.

Clare Murphy, Chief Executive of the British Pregnancy Advisory Service, the British Pregnancy Advisory Service, said: “The vast majority of pregnant women in the UK report use of medication for short-term or chronic conditions, and safe and effective prescribing is an essential component of antenatal care. Yet it is clear from our research that women’s health and wellbeing is being harmed by an overly precautionary approach. There is a prevailing cultural climate in which pregnant women’s own needs are often seen as secondary to her foetus. This has real consequences.”

Professor Marian Knight, Professor of Maternal and Child Population Health at the University of Oxford, who was not involved in the research, said: “This work shows very starkly the challenges pregnant women face trying to access medications in pregnancy. Women face conflicting advice and their healthcare professionals often do not recognise the importance of taking medication in pregnancy for pregnancy-specific conditions or pre-existing illnesses. This may sometimes have tragic consequences for either women or their babies. It is important that staff caring for pregnant women recognise the benefits of taking medication in pregnancy as well as how to access high quality information on medicine safety.”

“This research highlights that national guidance is frequently not used. We need knowledgeable healthcare providers who feel confident when prescribing to pregnant women, for women to feel involved and empowered in their treatment, and for more research into treatments for debilitating pregnancy conditions. Doing so will improve the safety and personalisation of prescribing in pregnancy and improve the care women receive,” added Professor Julia Sanders.

The paper, Women’s experiences of over-the-counter and prescription medication during pregnancy in the UK: findings from survey free-text responses and narrative interviews, was published in the BMJ Open journal.