Non-adherence to anti-hypertensives high during pregnancy


monochrome of pregnant belly

Pregnant women have poor adherence to anti-hypertensives, despite the risk of complications, study finds

Pharmacists have a major role to play in educating women on the need to remain adherent to their anti-hypertensive medicines, say the authors of a new Australian study.  

The observational study involved 100 pregnant women with either chronic or gestational hypertension, who were being treated with at least one anti-hypertensive medication and attending antenatal clinics at one of two maternity hospitals in Victoria.

“Nine out of ten pregnant women using anti-hypertensives self-reported some degree of suboptimal adherence—be it intentionally or unintentionally. Health professionals, including pharmacists, general practitioners and obstetricians, have a role to play in promoting optimal medication adherence,” said the authors, from the Centre for Medicine Use and Safety at Monash University, Melbourne.

“The main contributors to sub-optimal adherence were intentionally putting up with medical problems before taking any action, confusion about the medication, and making changes to the recommended medication regimen to suit lifestyle,” they said.

Study co-author, Amyna Helou, pharmacist and researcher, Faculty of Pharmacy and Pharmaceutical Sciences at Monash University, told AJP both community and clinical pharmacists can proactively encourage adherence to medication at various points throughout the pregnancy journey.

“In the case of women with a prescription for an anti-hypertensive, understanding whether this medication was started pre-pregnancy or during the pregnancy is important to tailor the adherence counselling.

“Community pharmacists, in particular, can play a significant role in clarifying the need for the medication during pregnancy. Allowing the women to discuss their concerns about the use of anti-hypertensives during pregnancy can be helpful.

Pharmacists can also assist by clarifying any conflicting information that the pregnant women may be receiving, especially from the Consumer Medicines Information (CMI) for commonly used anti-hypertensives during pregnancies, such as labetalol.

“Particularly during the first trimester, women who have already been prescribed an anti-hypertensive may have heightened concerns about continuing to take the medication taking during this phase of their pregnancy.

“Additionally, if at any time the medication changes to a different anti-hypertensive agent or the dose strength and/or frequency alters, pharmacists can help the patient to develop a new routine for their medication use.

“There is also a role for pharmacists to play in blood pressure monitoring at all of these stages to also contribute to optimising adherence,” she said. 

Ms Helou added, “Pharmacists should have sufficient knowledge of the conditions that require anti-hypertensives and the safety of using anti-hypertensives during pregnancy (including pregnancy safety categories and what they actually mean). This can help the women feel more confident to take advice from the pharmacist. Also, understanding the reasons for non-adherence for different conditions during pregnancy, such as those we identified in our study, can be helpful.”

The research was published in Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health.

 

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