Problemas relacionados a medicamentos em gestantes de alto risco

Abstract

Pregnant women are particularly vulnerable to medication-related problems (DRPs), especially those at high risk. Despite their relevance, data on frequency, type, cause, and associated factors in this population are scarce. In Latin America, as far as we know, there are no studies on this topic. The aim of this study was to characterize the PRMs in high-risk pregnant women with gestational hypertension (HG) and gestational diabetes mellitus (GDM) according to frequency, type, cause, and factors associated with their occurrence in the hospital setting. An observational, longitudinal, prospective study that included 571 hospitalized pregnant women with HG and GDM charts included from September 2019 to July 2022 in use of at least one medication. To identify the PRMs, inpatients were assessed daily during the entire hospitalization through active search by prescription analysis, active search in medical records, and daily interviews. The PRMs were classified according to the Classification for DrugRelated Problems (PCNE V9.00). In addition to descriptive statistics, a multivariate logistic regression model was used to determine factors associated with the MICs. Written informed consent was obtained from all patients. Results point to a prevalence of PRMs (63.8%) with a total of 873 identified occurrences. The most frequent MICs were related to therapeutic ineffectiveness (72.2%) and occurrence of adverse events (27.0%) and the main drugs involved were insulins and methyldopa. Thus, in the first five days of treatment, the ineffectiveness of insulin (24.6%), associated with underdose (12.9%) or insufficient frequency of administration (9.5%) and methyldopa associated with the occurrence of adverse reactions (40.2%) in the first 48 hours stand out. Lower maternal age (OR 0.966, 95% CI 0.938 - 0.995, p = 0.022), lower gestational age (OR 0.966, 95% CI 0.938 - 0.996, p = 0.026), report of drug hypersensitivity (OR 2.295, 95% CI 1.220 - 4.317, p = 0.010), the longer treatment time (OR 1.237, 95% CI: 1.147 - 1.333, p = 0.001) and number of prescribed medications (OR 1.211, 95% CI: 0.240 - 5.476, p = 0.001) were risk factors for occurrence of PRMs. In summary, PRMs are frequent in pregnant women with HG and GDM, predominantly therapeutic ineffectiveness associated with insufficient insulin dose and occurrence of adverse events, especially methyldopa adverse reactions in the first 48 h of treatment, with a tendency to decrease until the 5th day. Lower maternal age, shorter gestation time, report of drug hypersensitivity, longer treatment time, and number of prescribed drugs were associated with the occurrence of PRM.