Evaluating Knowledge and Decision-Making Related to Medication Use in Pregnancy

Theoretical Background and research questions/hypothesis: Most women (90%) take at least one prescription or over-the-counter medication during the first trimester of pregnancy. However, fewer than 10% of medications have sufficient information to determine their safety for use in pregnancy. Our objective was to better understand how women of childbearing age make decisions related to medication use during pregnancy.

Methods: We conducted six virtual focus groups with women who used medication, either while pregnant or while planning a pregnancy, to treat chronic or acute conditions (n=48). To conduct the virtual focus groups, we used a live chat platform to host groups as real-time, live chat sessions. A trained moderator used a semi-structured guide to post questions, probe for details, and facilitate discussion. Groups lasted 60–90 minutes and involved up to 12 participants per group. We then selected 1 or 2 participants from each group who provided compelling or noteworthy experiences for in-depth, follow-up interviews (n=12). Transcripts were independently reviewed and coded for analysis using NVivo 10.0 software.

Results: The majority of women acknowledged the importance of treating serious health conditions in pregnancy. However, they expressed concern and anxiety about the impact of medication use on their developing baby. Severity of the health condition was a factor in women’s decision-making: women needing medication to treat a severe condition felt more conflicted, while those with less serious symptoms felt able to make decisions more easily to lower their dosage or discontinue use in pregnancy. Many women responded that developing a treatment plan prior to pregnancy was optimal, but few women reported actually talking to their providers and creating a plan during that time. Overwhelmingly, women reported that their obstetricians/gynecologists were trusted sources who were able to provide expert opinions and recommendations about medication use in pregnancy. However, women felt that they had to be proactive in initiating conversations about medication use before, during, and after pregnancy. Hearing other people’s stories, by talking with friends and loved ones, as well as reading online blogs were powerful ways to supplement facts and research from doctors and other online sources. Finally, women recognized that while risks to taking medication while pregnant are often highlighted, the potential risks from not taking a medication should also be discussed.

Conclusions: While many women face difficult decisions about medication use in pregnancy, they feel confident seeking guidance from their healthcare providers as well as other contacts and online sources. This formative research helps to better understand knowledge, attitudes, practices, access to information, preferred information sources, and actions related to medication use in pregnancy. To help address the information needs of women, we recommend promoting more communication between patients and their providers regarding medication use. To ensure that these conversations occur, we recommend communication strategies targeting both patients and providers.

Implications for research and/or practice: This information can be used to develop strategies and optimize tools to improve awareness and decision-making among women of childbearing age regarding use of medications in pregnancy.