Treatment of Common Medical Problems in Pregnancy Part Ii

It is estimated that 40-90 % of women are exposed to medications during the course of their pregnancy, and 34% of women are medication free in the first trimester.2,50,76-81 Drug consumption is higher in pregnant women who engage in risk taking behaviour (e.g. smoking, alcohol, recreational drugs) and varies according to socioeconomic factors such as education, affluence and race.77 In one survey, 82% of women received an average of 4 drugs during pregnancy, excluding iron supplements, and 65% of women self-medicated.81 Moreover, women may tell their GP's of as few as 25% of the OTC preparations they have taken.82 Ideally, all drugs should be avoided in the first trimester,3,5,8 This recommendation is not always feasible.83 However, with reassurance and non-drug approaches, many women may be able to tolerate their discomfort. Physicians should prescribe in pregnancy where drugs are indicated; indeed failure to prescribe appropriate drug treatment may result in an adverse outcome.76 Physicians should stress the importance of avoiding self-medication (especially "natural" herbal remedies). Community pharmacists have a vital role to play in patient education and safe counter-prescribing during pregnancy.