The number of women of childbearing age receiving medication for high blood pressure, high cholesterol, and diabetes, is rising. Some of these medicines, if taken during pregnancy, have the potential to harm a baby. Although this is rare, women should be told about these risks. Our earlier published work focusing on medications for high blood pressure estimated that over half of women are not told about these risks nor advised to use contraception.
To our knowledge, this has not been expanded to look at a wider range of other potentially harmful medicines, to understand how big this problem is.
We aim to find out:
1) How often medications for high blood pressure, high cholesterol and diabetes are prescribed to women of childbearing age
2) What proportion of these women have a pregnancy?
3) What proportion of these women are prescribed contraception?
Methods
We will answer these questions by using the Clinical Practice Research Datalink which collects anonymised patient data from UK GP practices. We will look at the medical records of a sample of women aged 15-55 from this database to answer our aims.
Impact
We will use our results to understand how large this problem is in primary care and to find out whether current practice is putting women and their babies at potential risk. The knowledge we gain will be essential preliminary work towards improving care and prescribing in this area. It will also inform women and help them make optimal decisions about their treatments and pregnancy plans.
Increasing numbers of women are delaying motherhood to later years, when the prevalence of chronic conditions such as hypertension, hypercholesterolaemia and type 2 diabetes, increases. Recent estimates suggest these conditions could impact 1 in 5 women of reproductive age in the UK and medications are being increasingly prescribed to manage these conditions, many of which are teratogenic.
Our previous preliminary work estimated that 81.4% of women in a sample of 2651, were not told about the teratogenic risks of ACEi/ARBs (commonly used for hypertension), or advised to use contraception. Furthermore, a 2020 systematic review showed that highly teratogenic medicines subject to pregnancy prevention programs, are associated with low rates of pre-conception counselling.
To our knowledge, this data has not been extended to examine more commonly prescribed teratogens in primary care on a national scale, including ACEi/ARBs, statins and anti-diabetic medications, which can cause reduced fetal growth, poor lung and limb development.
Aims
1) How often are women of reproductive age prescribed ACEi/ARBs, statins and anti-diabetic medications?
2) What proportion of these women become pregnant?
3) What proportion of these women are prescribed contraception?
Methods
Retrospective cohort study of women aged 15-55 between 2015 -2020 prescribed a medication/s of interest. We will use CPRD’s linked pregnancy registry to quantify what proportion of these women become pregnant, and/or are prescribed contraception in the year following their prescription for a medication of interest, until end of the study period or CPRD registration, or death, whichever occurs first. We will report using descriptive statistics.
Impact
No previous studies have quantified the scale of this prescribing problem in the UK. Our results will be disseminated to patients, GPs and regulatory bodies to raise awareness around prescribing teratogens in primary care and to prioritise future research to facilitate design of safer prescribing systems.
Prescriptions of ACEi/ARB, anti-diabetic medications (excluding metformin and insulin) and statins in women aged 15-55; contraception prescriptions; pregnancy
Elizabeth Lovegrove - Chief Investigator - University of Southampton
Elizabeth Lovegrove - Corresponding Applicant - University of Southampton
Danielle Schoenaker - Collaborator - University of Southampton
Hajira Dambha-Miller - Collaborator - University of Southampton
Miriam Santer - Collaborator - University of Southampton
Beth Stuart - Collaborator - Queen Mary University of London
Douglas Steinke - Collaborator - University of Manchester
Patricia McGettigan - Collaborator - Queen Mary University of London
Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;CPRD Aurum Pregnancy Register;CPRD GOLD Pregnancy Register