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Abstract
Introduction: Data reliability must be considered before using administrative healthcare databases to study medication utilisation and safety during pregnancy.
Objectives: To compare medication use reported by the mother and recorded by midwives at the first antenatal visit in the Northern Ireland (NI) Maternity System (NIMATS) to dispensed prescriptions recorded in the Enhanced Prescribing Database (EPD).
Methods: A population-based linked cohort study including all resident women in NI who gave birth between 01/01/2011 and 31/12/2016. Prescriptions dispensed in the EPD between the last menstrual period and the first antenatal visit were compared to medications recorded in NIMATS. The number and proportion of pregnancies with medications in each data source were calculated along with Cohen’s kappa, sensitivity and specificity.
Results: Of the 139,687 pregnancies in NIMATS (106,206 women), 74.3% reported taking medication, including supplements, and 63.5% had prescriptions dispensed (with 86.9% reporting taking medication or having a prescription dispensed). Excluding supplements, 18.2% reported medication use, while 48.7% had prescriptions dispensed. In NIMATS, 20.4% of pregnancies had vitamins and 1.2% antacids compared to 1.4% and 0.1% respectively in EPD. All other medications were more commonly prescribed than reported, with moderate agreement for antiemetics (kappa 0.42, 95% CI 0.41-0.43), anticoagulants (kappa 0.62, 95% CI 0.61-0.64) and antihypertensives (kappa 0.62, 95% CI 0.61- 0.64). Agreement was lowest for 400mg folic acid (kappa -0.09, 95% CI -0.10 - -0.09). There was considerable underreporting of medicines for chronic use, such as antiepileptics, at the first antenatal appointment.
Conclusions: Medication use during early pregnancy was common. Women obtained vitamins and antiacids over the counter rather than by prescription, but all other medications were prescribed more. Non-compliance and discontinuation may explain some of the disagreement, but reporting of prescribed medicines for chronic illnesses was incomplete in antenatal records. To identify all medication use, combining maternal reporting with prescribing data is recommended.
Objectives: To compare medication use reported by the mother and recorded by midwives at the first antenatal visit in the Northern Ireland (NI) Maternity System (NIMATS) to dispensed prescriptions recorded in the Enhanced Prescribing Database (EPD).
Methods: A population-based linked cohort study including all resident women in NI who gave birth between 01/01/2011 and 31/12/2016. Prescriptions dispensed in the EPD between the last menstrual period and the first antenatal visit were compared to medications recorded in NIMATS. The number and proportion of pregnancies with medications in each data source were calculated along with Cohen’s kappa, sensitivity and specificity.
Results: Of the 139,687 pregnancies in NIMATS (106,206 women), 74.3% reported taking medication, including supplements, and 63.5% had prescriptions dispensed (with 86.9% reporting taking medication or having a prescription dispensed). Excluding supplements, 18.2% reported medication use, while 48.7% had prescriptions dispensed. In NIMATS, 20.4% of pregnancies had vitamins and 1.2% antacids compared to 1.4% and 0.1% respectively in EPD. All other medications were more commonly prescribed than reported, with moderate agreement for antiemetics (kappa 0.42, 95% CI 0.41-0.43), anticoagulants (kappa 0.62, 95% CI 0.61-0.64) and antihypertensives (kappa 0.62, 95% CI 0.61- 0.64). Agreement was lowest for 400mg folic acid (kappa -0.09, 95% CI -0.10 - -0.09). There was considerable underreporting of medicines for chronic use, such as antiepileptics, at the first antenatal appointment.
Conclusions: Medication use during early pregnancy was common. Women obtained vitamins and antiacids over the counter rather than by prescription, but all other medications were prescribed more. Non-compliance and discontinuation may explain some of the disagreement, but reporting of prescribed medicines for chronic illnesses was incomplete in antenatal records. To identify all medication use, combining maternal reporting with prescribing data is recommended.
| Original language | English |
|---|---|
| Journal | International Journal of Population Data Science |
| Publication status | Accepted/In press - 12 Aug 2025 |
Data Access Statement
All relevant data are within the paper and its supporting information files. The raw data is available to accredited researchers upon application to the Honest Broker Service: https://bso.hscni.net/directorates/digital/honest-broker-service/.Funding
HD and ML received funding for this study from the Economic and Social Research Council (https://esrc.ukri.org/), grant number ESL/ L007509/1 (Administrative Data Research Centre —Northern Ireland). JG is a member of, and received support from, the UK Prevention Research Partnership Maternal and Child Health Network (MR/S037608/1). The funders had no role in study design, data collection and analysis, publication decisions, or manuscript preparation.
Keywords
- Pregnancy
- Pharmaceutical Preparations
- Information Storage and Retrieval
- Self-Report
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Sociodemographic variation in prescriptions dispensed in early pregnancy in Northern Ireland 2010–2016
Given, J., Casson, K., Dolk, H. & Loane, M., 22 Aug 2022, In: PLoS ONE. 17, 8, p. 1-15 15 p., e0267710.Research output: Contribution to journal › Article › peer-review
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