J Am Pharm Assoc (2003). 2021 May-Jun;61(3):325-330. doi: 10.1016/j.japh.2021.01.022. Epub 2021 Feb 12.
Certain prescription medications should be avoided during pregnancy to reduce the risk of fetal harm. Identification of these medications to minimize exposure may be achieved through the integration of preconception care recommendations into medication therapy management (MTM) services. The primary objective of this study was to identify missed opportunities for pharmacists to provide preconception care support related to medications associated with adverse pregnancy outcomes for reproductive-aged women who received MTM consultations at a regional supermarket pharmacy chain. Secondary objectives examined the concurrent use of prenatal vitamins, folic acid, or hormonal contraception in patients receiving medications associated with adverse pregnancy outcomes.
The study examined all MTM and prescription drug claims submitted by a regional chain of supermarket pharmacies from January 1, 2018 to June 30, 2019, to identify female patients aged 15-45 years who received MTM services. Prescription claims were cross-referenced to determine which of these patients also received medications associated with adverse pregnancy outcomes. To identify patients with long-term use of opioids and nonsteroidal anti-inflammatory drugs, a restriction based on days supplied was then applied.
Of the 2020 female patients who received MTM services and filled at least 1 prescription during the study period, 731 (36.2%) were found to have received at least 1 medication associated with adverse pregnancy outcomes for the minimal days' threshold. Of these, 509 (69.6%) lacked evidence of concurrent prescription contraception, and 74 (10.1%) had a concurrent prescription for folic acid or prenatal vitamins.
The use of medications associated with adverse pregnancy outcomes was widespread in this sample of reproductive-aged women. The findings of this study indicate the need for additional research to investigate the implementation of targeted MTM interventions to build standard workflow processes and facilitate pharmacists' management of this critical clinical issue.
为降低胎儿损伤风险，某些处方药物应避免在孕期使用。通过将孕前保健建议纳入药物治疗管理（MTM）服务，可识别这些药物以尽量减少暴露。本研究的主要目的是确定药剂师在为接受 MTM 咨询的育龄妇女提供与不良妊娠结局相关药物的孕前保健支持方面存在的错失机会，这些妇女在区域连锁超市药房接受 MTM 咨询。次要目标检查了同时使用产前维生素、叶酸或激素避孕药与不良妊娠结局相关药物的患者。
本研究分析了区域连锁超市药房自 2018 年 1 月 1 日至 2019 年 6 月 30 日提交的所有 MTM 和处方药索赔，以确定接受 MTM 服务且年龄在 15-45 岁之间的女性患者。交叉参考处方索赔，以确定这些患者中哪些患者还接受了与不良妊娠结局相关的药物。为了识别长期使用阿片类药物和非甾体抗炎药的患者，然后基于供应天数进行限制。
在接受 MTM 服务且在研究期间至少开具 1 张处方的 2020 名女性患者中，有 731 名（36.2%）患者至少开具了 1 种与最小天数阈值相关的不良妊娠结局药物。在这些患者中，有 509 名（69.6%）缺乏同时开具避孕处方的证据，有 74 名（10.1%）同时开具了叶酸或产前维生素处方。
在该育龄妇女样本中，与不良妊娠结局相关的药物使用非常普遍。本研究结果表明需要进行更多研究，以调查实施有针对性的 MTM 干预措施的情况，以建立标准工作流程并促进药剂师管理这一关键临床问题。
