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Introduction: Medication use during pregnancy is limited by the scarcity of safety data for many drugs. The use of certain drugs during pregnancy can be teratogenic. Overestimating teratogenic medication risk could have serious consequences from drug non-adherence. Assessing and understanding the knowledge, attitude, and practice of medication use among pregnant women is crucial to optimizing the health of pregnant women and their fetuses. Methodology: An observational cross-sectional study used convenience and snowball sampling with a self-administered online questionnaire in pregnant women from Riyadh City. The questionnaire used was adapted from previously published surveys. The survey included sections on sociodemographic background, awareness of medication risks, medication use during pregnancy, sources of drug information, and statements from the Beliefs about Medicines Questionnaire BMQ , both general and pregnancy-specific. Results: Medication use during pregnancy was reported by The primary source for medication information for the majority was the physician. Additionally, The responses to the questionnaire reveal a commendable level of knowledge and positive attitude and practice. However, variations could be found in these responses. Overall, no evident relationships were observed between predictors and responses, except in specific statements that indicated a positive association between beliefs and higher levels of education and youth. Conclusion: The results suggest a positive knowledge, attitude, and practice level. However, there was hesitancy and a restrictive attitude towards medication during pregnancy. The study identified inadequate education provided by healthcare professionals, thus presenting an area for improvement to enhance the safety and efficacy of medication use during pregnancy. Pregnancy is a distinctive physiological state that necessitates meticulous consideration regarding medication use. The altered pharmacokinetics during pregnancy create challenges and concerns when determining the safety of medications for both the mother and the developing fetus. Nonetheless, the use of medications is often essential to treat acute medical conditions during pregnancy 1 , 2. Over the past four decades, there has been a noticeable increase in medication use among pregnant women, whether prescribed or non-prescribed. This trend can be attributed to the fact that many women are now becoming pregnant at an older age, often with pre-existing chronic medical conditions that require ongoing treatment 1 , 3. In one study, it was found that four out of five pregnant women were prescribed one or more medications, ranging from multivitamins and supplements to over-the-counter drugs and various prescribed medications to treat different medical conditions 4. Another study conducted among pregnant women at an ambulatory care clinic revealed that However, the use of medication during pregnancy is constrained by the lack of comprehensive safety data, complicating clinical decisions and posing health risks to both the mother and the fetus. The teratogenic effects of thalidomide prompted legal and regulatory decisions to exclude pregnant women from clinical trials, adversely affecting drug development and resulting in unreliable data with added safety concerns related to drug teratogenicity 7. Teratogenic substances are defined as substances that can negatively affect embryo or fetal development if administered to pregnant women. These substances can harm the embryo or fetus in several ways, causing congenital malformations, behavioral or emotional development issues, and reduced intellectual quotient in the child. Additionally, teratogens can also lead to pregnancy complications, such as preterm labor, or abortions 8 , 9. Numerous substances, including certain medications, have been identified as teratogens Medication beliefs significantly influence medication adherence, reflecting compliance with prescriber instructions. Several studies have documented the overestimation of teratogenic risks associated with medications 12 , A large-scale multinational survey encompassing 18 countries from Europe, North America, and Australia found that pregnant women often overestimate the risks of antidepressants and antibiotics Such overestimations can lead to medication non-adherence, which is particularly critical in managing chronic diseases. Non-adherence can result in severe consequences for both the pregnant woman and the fetus, including fetal death and pregnancy termination This low adherence rate leads to suboptimal management of chronic health conditions. Women generally perceive medication use during pregnancy as potentially harmful to the fetus, which makes them reluctant to use prescribed drugs during this period. Several factors contribute to this behavior, including personal beliefs and health literacy One study investigating why pregnant women choose not to treat nausea and vomiting with pharmacologic medications found that concerns about potential teratogenic effects lead many to opt for non-pharmacologic alternatives, such as herbal remedies, which are perceived to carry fewer safety risks In one study by Alkhaldi and Alkhammash involving pregnant women from Taif City, Saudi Arabia, the prevalence of using herbal medicines during pregnancy was These behaviors and attitudes toward medication use during pregnancy have garnered attention and have been studied in multiple countries. Healthcare professionals need to understand the restrictive attitudes and practices of pregnant women regarding medication use to provide optimal and safe patient care. For instance, in developing countries, it has been reported that pregnant women frequently self-medicate without a prescription due to a lack of knowledge and awareness Given these circumstances, pregnant women often seek information from various sources with varying degrees of accuracy and reliability Studies have shown that pregnant women frequently rely on online sources for information about pregnancy and medications, reflecting a growing desire to access accurate and relevant information conveniently 21 , One review revealed that pregnant women often view online health information as reliable and helpful for making informed decisions about their well-being However, caution is necessary, as inappropriate and inconsistent information regarding the safety of medications during pregnancy is common on many websites. Encountering conflicting online information can lead to medication reluctance and increased anxiety This issue is further compounded by the fact that pregnant women may not always discuss the information they find online with healthcare professionals, leading to gaps in understanding and potentially hindering effective treatment plans In conclusion, the knowledge, attitudes, and practices of pregnant women towards medications significantly influence their use. The objective of this study is to assess the knowledge, attitudes, and practices regarding medication use among pregnant women in Riyadh city, aiming to optimize healthcare for both pregnant women and their fetuses. This observational cross-sectional study utilized a self-administered questionnaire to gather data. The study population included all pregnant women residing in Riyadh City. Convenience and snowball sampling techniques were employed to recruit participants using WhatsApp and emails, and data were collected using an online questionnaire. The data collection period spanned one month, from March to April Inclusion criteria comprised all pregnant women living in Riyadh during the study period who consented to participate in the questionnaire. The survey package, available in both Arabic and English, included details about the study and its purpose, informed consent, and the questionnaire itself. The questionnaire was adapted by Zaki and Albarraq in from two previously published surveys by Horne et al. The questionnaire evaluated sociodemographic characteristics Q1—5 , awareness of risk Q6—Q9 , current medication use Q10—Q13 , and sources of drug information Q14—Q Statements G1—G7 were used to assess beliefs about medication using the Beliefs about Medicines Questionnaire BMQ , while statements S1—S8 evaluated attitudes and practices regarding medication use during pregnancy. The complete questionnaire is included in Appendix 1. The questionnaire was designed in Arabic and English to accommodate both Arabic and non-Arabic-speaking participants. Its content validity was reviewed by an independent pharmacist and physician. Face validity was established through translation into Arabic by a certified translator, ensuring consistency between the English and Arabic versions. A pilot study involving 35 participants led to the rewording of two questions and the omission of one question based on participant feedback. A back-translation from Arabic to English confirmed that the text matched the original questionnaire. The participants' identities remained anonymous throughout the study. Informed consent was obtained, and all participants were informed about the purpose of the study. Participants had the right to withdraw at any time without obligation to the study team. No incentives or rewards were given to the participants. There was no funding for the research. We estimated that there were 70, pregnant women in the Riyadh population. Thirty-five participants who took part in the pilot study were excluded from the final data analysis. Data analysis was performed using Jamovi, version 2. Categorical data were presented as frequencies and percentages. Logistic regression was used to identify factors influencing the responses. Disagreeing responses served as the reference level for all statements. The analysis included the following predictors: age group, education level, number of pregnancies, nationality, and presence of chronic disease. The responses to the questions and statements were treated as dependent variables. Models were determined using stepwise regression, and all analyses were controlled for age, education level, and number of pregnancies. Outliers were checked for excess leverage. The study included pregnant women residing in Riyadh City, Saudi Arabia. Among the participants, Most participants, Regarding employment status, Detailed sociodemographic information is presented in Table 1. The total number of chronic conditions was 66, including 15 different chronic disease categories. The most common chronic conditions were thyroid disorders, affecting Additionally, out of the participants Regarding awareness of risk, the majority of participants, specifically Notably, a significant majority of participants who used prescribed medications were aware of the indications for their medication, with out of As illustrated in Figure 1 , A substantial majority of the participants, numbering Among them, Furthermore, Only Moreover, A minority, comprising 38 6. Regarding natural remedies, Interestingly, Further details are provided in Tables 5 , 6. Overall, the analysis revealed three notable associations between predictors and responses. Lastly, age-related differences in responses were observed, particularly regarding the belief that pregnant women should not use natural remedies without a doctor's advice Statement S8. It is worth noting that there were only two pregnant women less than 20 years of age, both of whom agreed with the statement. Rerunning the statistical analyses excluding these two individuals yielded unchanged relationships. Additionally, a sensitivity analysis was conducted, excluding healthcare-related employees 88 out of participants , to mitigate potential bias due to medical knowledge among participants from the healthcare sector. In our study, pregnant women residing in Riyadh City, Saudi Arabia, participated in an online questionnaire aimed at assessing their knowledge, attitude, and practice regarding medication use during pregnancy. The findings revealed a commendable level of knowledge and a positive attitude and practice towards medication use. However, a conservative attitude towards medication use during pregnancy was observed, consistent with prior reports by Zaki and Albarraq in the Saudi population. Our study did not find significant associations between sociodemographic variables and participants' responses, except for three specific statements. This finding is in line with the results of Obi and Anosike's study on the Nigerian population, where no associations were identified between sociodemographic variables and responses Demographic analysis of the participants revealed that the majority fell within the 20 to 30 age range, had a high level of education, and were of Saudi nationality. However, it's worth noting that this high level of education may be inflated due to sampling techniques. Furthermore, nearly half of the participants were primigravida, and the majority reported good health, with only In terms of medication use during pregnancy, However, this percentage is lower compared to other studies, including those conducted in Italy Moreover, our percentage was higher than that reported in Australia Interestingly, a recently published study in Riyadh City by Alyami et al. However, this study was conducted at King Saud Medical City, a tertiary care hospital that likely includes more complicated pregnancy cases, which may explain the difference in results. According to the study, Regarding awareness of risks, participants demonstrated a commendable level of knowledge, with the majority being aware of critical periods during pregnancy and drugs to avoid. Furthermore, a significant majority of participants using prescribed medications demonstrated awareness of their medication indications, indicating a remarkable level of awareness. This reliance on physicians is notable, particularly given the potential risks associated with obtaining information from non-trusted sources on the internet and social media. This finding aligns with previous research by Zaki and Albarraq, where physicians were the primary source of medication information for However, our findings contrast with other published data that emphasize the internet as a common resource for medication information among pregnant women. Similarly, in Italy, Moreover, participants in our study demonstrated commendable practice by regularly attending physician visits during pregnancy. It is noteworthy that in Saudi Arabia, maternity services are provided for free through the public governmental sector or health insurance, potentially positively impacting this practice. However, a concerning aspect emerged as This information deficiency may adversely impact their knowledge, attitude, and practice, aligning with the findings of Zaki and Albarraq Also, it is aligned with the findings of Alyami et al. The insufficient information provided by physicians and pharmacists may be related to the knowledge gap identified in previous studies conducted in Saudi Arabia by Alshebly et al. Moreover, a systematic review examining patients' knowledge and sources of information regarding medication use during pregnancy found that the majority of women had information gaps concerning prescribed medications, regardless of the country. Five studies noted that patients believed the information provided by physicians was insufficient This suggests a need for improved training and continuing education programs for healthcare professionals to ensure they have the knowledge to provide comprehensive and accurate patient information. Furthermore, in our study most participants mentioned that they routinely read the medication leaflet accompanying prescribed medication during pregnancy. This cautious approach is consistent with the findings of Zaki and Albarraq in Taif, Saudi Arabia 15 , reflecting a hesitancy toward using medications during pregnancy, especially in the absence of comprehensive and trusted information provided by physicians and pharmacists during the prescribing and dispensing of medications. Regarding beliefs about medication use during pregnancy, the overall survey responses reflect a positive outlook. Notably, Zaki and Albarraq conducted a similar study in in Taif, Saudi Arabia, focusing on assessing medication use, knowledge, and beliefs among pregnant women. A detailed comparison of responses between our sample and theirs indicates both differences and agreements, as evidenced in Tables 7 , 8. Additionally, for a more comprehensive comparison, we integrated data from a distinct population Belgium , as presented in the study by Ceulemans et al. This additional layer of analysis provides a broader perspective on medication beliefs and practices among pregnant women across various populations. Approximately one-third of participants expressed the belief that doctors generally prescribe too many medicines, with around Notably, Saudi women exhibit a higher inclination to disagree with these statements compared to non-Saudi women. However, caution is warranted in interpreting this observation due to the limited number of non-Saudi participants. These findings are consistent with Zaki and Albarraq's results, where over half of the participants expressed beliefs that doctors generally prescribe too many medicines and place excessive trust in them. Moreover, the responses to other statements were comparable Interestingly, the study conducted in Belgium indicates lower agreement on the aforementioned statements, suggesting a higher level of trust and belief in the healthcare system. However, it is essential to acknowledge that both the Zaki and Albarraq, and Ceulemans et al. Furthermore, a majority of participants in our study express positive beliefs, asserting that medications are neither addictive nor poisonous and that not all medications are harmful to the fetus. Additionally, over half of the participants believe that the benefits of medicines outweigh their risks in general. Notably, these responses align more closely with the findings of the Belgium study than the previous Saudi study, which reported a more skeptical attitude toward medications, particularly among participants with lower education levels. Significantly, our study identifies an association between responses reflecting beliefs about medication effects on the fetus and the level of education, suggesting a positive belief associated with a higher level of education. This influence of education on beliefs about medication use has been demonstrated in previous studies across different communities, including those in Saudi Arabia and Belgium 15 , It is noteworthy that, in terms of education level, our study population includes the highest number of participants with a high level of education compared to the other two studies. The conservative attitude towards medication use among participants in the three distinct cohorts was comparable, with the majority expressing a higher threshold for using medicines during pregnancy compared to when not pregnant. However, the results of this study are reassuring, indicating that the majority of pregnant women do not believe that medications prescribed by physicians for medical conditions are poisonous and can lead to harm. Furthermore, most participants recognize the beneficial effects of prescribed medication for a medical condition, both for themselves and their fetus. Our results align with those of the previous Saudi study, whereas the Belgian study indicates a higher preference for using natural remedies among pregnant women 15 , This difference may highlight the variations between the communities in general. However, the majority of participants across all discussed studies believe that pregnant women should not use natural remedies without a doctor's advice. Notably, age-dependent variations in responses were observed in our study, with the younger age group more likely to agree that pregnant women should not use natural remedies without the advice of a doctor. Based on the study findings, implementing education and communication initiatives for healthcare professionals to enhance medication education activities, particularly in situations with limited information, will significantly impact public health. Furthermore, developing unified guidance with updated evidence-based information for healthcare professionals and pregnant women will be helpful to ensure the provision of trusted, consistent, and higher-quality evidence-based information. The study's strengths are multifaceted. First, it effectively identifies and addresses various dynamic aspects of women's attitudes and practices toward medication during pregnancy, providing a nuanced understanding of this critical issue. Second, the study ensures a more comprehensive and representative population by utilizing a large sample size and targeting pregnant women who receive diverse healthcare services from different providers. This approach enhances the generalizability of the findings. Last, using a questionnaire, previously utilized in other studies, facilitates the comparison of the findings across different populations and adds to the reliability of the study's outcomes. However, the study is constrained by its observational design and sampling approach, including the dissemination channels for the questionnaire, which could have introduced biases, as well as the inability to quantify the response rate. The predominantly highly educated participant pool could potentially skew results positively, as observed in previous research. While employing anonymous self-reported surveys aids in mitigating social desirability bias, it remains susceptible to response bias. Furthermore, the accuracy of health status data and medication use history can be affected by self-reporting. Moreover, the lack of detailed information on pregnancy trimesters could limit the interpretation of results. The overrepresentation of primigravida participants and individuals without chronic health conditions might not fully reflect medication attitudes in more diverse populations. Lastly, the study's location in Riyadh city, the capital city of Saudi Arabia, may limit generalizability to regions with fewer healthcare resources. In conclusion, the present study offers valuable insights into the current landscape of knowledge, attitudes, and practices concerning medication use among pregnant women in the capital city of Saudi Arabia. While the overall findings suggest a positive outlook, there are discernible variations in responses indicating a degree of hesitancy and a cautious approach toward medication during pregnancy. Healthcare professionals need to acknowledge and account for this attitude when prescribing medications for pregnant women, as understanding the beliefs held by this demographic can significantly influence safety and outcomes. Furthermore, the study highlights a concerning inadequacy in the education provided by healthcare professionals regarding medication use during pregnancy. This shortfall in information from frontline healthcare providers underscores an area for improvement aimed at enhancing the safety and effectiveness of medication use in pregnant women. Addressing this education gap holds the potential to positively impact the care and well-being of pregnant women. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. The views expressed in this paper are those of the authors and not do not necessarily reflect those of their institutions. Ayad M, Costantine MM. Epidemiology of medications use in pregnancy. Semin Perinatol. Knowledge, beliefs, and practice of pregnant women regarding medication use during pregnancy: a hospital-based cross-sectional study. J Obstet Gynaecol. Medication use during pregnancy, with particular focus on prescription drugs: — Am J Obstet Gynecol. Medicines in pregnancy. Crossref Full Text Google Scholar. Medication use for chronic health conditions by pregnant women attending an Australian maternity hospital. Ito S. Mother and child: medication use in pregnancy and lactation. Clin Pharmacol Ther. Pregnancy and medicines: time for paradigm change. Embryo Project Encyclopedia ISSN: Google Scholar. Dathe K, Schaefer C. The use of medication in pregnancy. Dtsch Arztebl Int. Risk management of teratogenic medicines: a systematic review. Birth Defects Res. Horne R, Weinman J. J Psychosom Res. Perception of teratogenic risk of common medicines. Perception of risk regarding the use of medications and other exposures during pregnancy. Eur J Clin Pharmacol. BMJ Open. Use, attitudes and knowledge of medications among pregnant women: a Saudi study. Saudi Pharm J. Differences in medication beliefs between pregnant women using medication, or not, for chronic diseases: a cross-sectional, multinational, web-based study. J Midwifery Womens Health. Prevalence, knowledge, and attitudes toward herbal medicines among pregnant women attending antenatal clinic in Prince Mansour Military Hospital in Taif. J Family Med Prim Care. Self-medication: potential risks and hazards among pregnant women in Uyo, Nigeria. Pan Afr Med J. PubMed Abstract Google Scholar. Use of the internet by women seeking information about potentially teratogenic agents. Multiple information sources and consequences of conflicting information about medicine use during pregnancy: a multinational internet-based survey. J Med Internet Res. Larsson M. A descriptive study of the use of the internet by women seeking pregnancy-related information. Sayakhot P, Carolan-Olah M. Internet use by pregnant women seeking pregnancy-related information: a systematic review. BMC Pregnancy Childbirth. Ann Pharmacother. Obi OC, Anosike C. A cross-sectional study on the knowledge, attitude, and practice of pregnant women regarding medication use and restriction during pregnancy. Explor Res Clin Soc Pharm. Stat Bulk Data Download Service. Available online at: apiportal. Drug use during early pregnancy: cross-sectional analysis from the Childbirth and Health Study in Primary Care in Iceland. Scand J Prim Health Care. Prevalence of prescribing in pregnancy using the Irish primary care research network: a pilot study. The French Pregnancy Cohort: medication use during pregnancy in the French population. PLoS One. Use, awareness, knowledge and beliefs of medication during pregnancy in Malaysia. Osong Public Health Res Perspect. Drugs dispensed in primary care during pregnancy: a record-linkage analysis in Tayside, Scotland. Drug Saf. Effects of personality on use of medications, alcohol, and cigarettes during pregnancy. The Quebec pregnancy cohort—prevalence of medication use during gestation and pregnancy outcomes. Determinants of prescribed drug use among pregnant women in Bahir Dar city administration, Northwest Ethiopia: a cross-sectional study. Knowledge, attitudes, and practice regarding medication use in pregnant women in Southern Italy. Trends of over-the-counter and prescribed medication use during pregnancy: a cross-sectional study. J Multidiscip Healthc. Knowledge, attitude, and beliefs of medication use in pregnancy in an urban tertiary care center. J Clin Pharmacol. J Adv Nurs. Knowledge of community pharmacists about the risks of medication use during pregnancy in central region of Saudi Arabia. Knowledge, information sources, and institutional trust of patients regarding medication use in pregnancy: a systematic review. J Family Reprod Health. Beliefs about medicines and information needs among pregnant women visiting a tertiary hospital in Belgium. Please fill in the required information and Tick the most accurate answer:. Less than 20 years. More than Education level:. High School. Healthcare related employee. Employee others. Number of pregnancies:. More than 3. Do you have any chronic diseases? If yes, please specify which disease …. What is the critical time for drug use during pregnancy? First trimester 1—3 months. Second trimester 4—6 months. Third trimester 7—9 months. Are you aware of drugs that should be avoided during pregnancy? I'm not sure. Do you take any drugs without a prescription during pregnancy? From where did you obtain drug information? Medication leaflet. If you have a prescribed medication during pregnancy, do you read the medication leaflet? Do you visit your doctor regularly during pregnancy? Womens Health 5 : The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Top bar navigation. About us About us. Sections Sections. About journal About journal. Article types Author guidelines Editor guidelines Publishing fees Submission checklist Contact editorial office. Womens Health , 24 July Knowledge, attitude, and practice of medication use among pregnant women in Riyadh City: a cross-sectional study. Introduction Pregnancy is a distinctive physiological state that necessitates meticulous consideration regarding medication use. Methodology Study design and population This observational cross-sectional study utilized a self-administered questionnaire to gather data. Data collection The survey package, available in both Arabic and English, included details about the study and its purpose, informed consent, and the questionnaire itself. Statistical analysis We estimated that there were 70, pregnant women in the Riyadh population. Table 7 Beliefs about medication general comparison. Table 8 Beliefs about medication during pregnancy specific comparison. Keywords: pregnancy, awareness, medication use, public health, Saudi Arabia Citation: Almuhareb A, Al Sharif A and Cahusac P Knowledge, attitude, and practice of medication use among pregnant women in Riyadh City: a cross-sectional study.

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