Pregnant Callers Commonly Ask Pharmacists About Psychiatric Medications

Pregnant patients most often consult with pharmacists and other health care professionals on medications for psychiatric disorders and infectious diseases, a retrospective analysis published in the Journal of the American Pharmacists Association suggests.

Researchers from Duke University Medical Center studied 433 provider inquiries logged into the University of North Carolina Health Care System Drug Information Center database between January 2001 and December 2010. Data collected from participants included provider type, date of inquiry, caller location, medication name, drug exposure class, gestational period at time of inquiry, indication for medication inquiry, and type of information requested.

The inquiries were divided into 2 main categories: indication for treatment—comprised of therapeutic areas like analgesia, contraception, fertility, neurology, oncology, psychiatry, and rheumatology—and reason for inquiry, described by medication availability, closing guidance, interactions, recommendations, and safety concerns.

"We hypothesized that our proposed analysis would identify classes of medications of most concern to providers, and identify opportunities for focused educational efforts to improve the use of necessary medications in pregnancy," the authors wrote.

Physicians comprised half of the provider types in documented callers (137 inquiries), followed by pharmacists (59), nurses (49), and physician assistants (3). The remaining 157 calls' provider types were not identified.

Pregnant callers most often inquired about medication use in the antepartum period (147 calls), while postpartum and preconception medication use followed, with 120 calls and 95 calls, respectively. The remaining 71 calls did not concern information about the gestational period.

Most notably, 96% of postpartum inquiries were related to medication use during breastfeeding, and more than half (54%) of preconception inquiries were related to drug interactions with a caller’s current contraceptive agents.

The researchers noted that the most frequent reasons behind inquiry calls were psychiatry (15%), infectious disease (14%), and contraception (14%). Half of psychiatry concerns involved antidepressants, including selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors. Other psychiatry-related inquiries concerned the use of antipsychotics (11%), antiepileptic medications (7%), and benzodiazepines (6%).

Infectious disease-related calls were most frequently about antibiotics (68%), followed by vaccines (29%), antiparasitics (18%), antivirals (18%), and antifungals (4%).

When comparing the first 5-year period to the second, researchers identified an increase from 7% to 12% of total obstetric inquiries, which included pre-term labor, hyperemesis gravidarum, cervical ripening, postpartum hemorrhage, and short cervix. Dermatology and analgesia demonstrated a relative decline from 7% to 2% and 6% to 2%, respectively.

“Psychiatry- and infectious disease-related medications are consistently the subject of the most inquiries,” the authors concluded. “While there has been an improvement in the availability of information for providers and an acceptance of descriptive guidance on medication use in pregnancy, the subject of provider inquiries has remained essentially unchanged over the past decade. This information emphasizes the importance of focused research and educational efforts to address the uncertainties surrounding the use of medications in pregnancy.”