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Over the Counter Drugs Use by Libyan Women before and during Pregnancy

Samia A. Hassan, Fatma M. Ben Rabha, Mabruka S. Elashheb, Lamees A. Ben Saad, Nagat M. Saeed, Mahmoud A . Arhima, Hiyam Bin Rajab


Information on the safety of drugs is particularly important during pregnancy because pregnant women may have chronic diseases requiring medical intervention, for example, epilepsy, diabetic mellitus, or asthma. Alternatively, they develop pregnancy-induced problems such as hypertension or diabetes. For both situations, drug use in pregnancy is necessary. To avoid all drugs in pregnancy is unreasonable and may be dangerous. The main aim of this study was to measure the frequency and distribution of exposure to different types of drugs and chemicals (over the counter (OTC) and prescribed) before and during pregnancy in current Libyan women. The self-report questionnaire was designed to elicit information on the women’s prescribed, non-prescribed OTC, and social drug use during the first trimester of pregnancy and in the 3 months prior to pregnancy. The most common nutritional supplements before and during pregnancy were folic acid, multivitamins, iron, zinc, vitamin C, vitamin D, and calcium. A small number of women (n=5, 15%) took folic acid and multivitamins during the preconception period compared with 12 (35%) who used these agents during pregnancy. Iron and calcium were infrequently used before and during pregnancy. A small number of women (n=4, 12%) took oral vitamin during the preconception compared with (n=6, 18%) who received vitamin D injection (IM) during pregnancy. Paracetamol use slightly decreased with knowledge of pregnancy. Antibiotics were the most frequently prescribed medicines during pregnancy, with 9 women (26%) receiving these agents, usually azithromycin, amoxicillin, or coamoxiclav. During both the preconception and post-conception periods, four women used salbutamol for asthma. The results of this study confirm that the drug use during pregnancy is common, and several drugs may be used, often to treat specific issues associated with pregnancy or chronic disease. However, for OTC group, use is reduced compared to the period before pregnancy.


Drug information, Libya, nutritional supplements, pregnancy

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Irl C, Hasford J. Assessing the safety of drug in pregnancy: the role of prospective cohort studies. Drug Safety. 2000; 22(3): 169–177.

Chen W-J A, Maie SE. Combination drug use and risk for fetal harm. Alcohol Res Health. 2011; 34(1): 27–28.

Mitchell AA, Gilboa SM, Werler MM, Kelley KE, Louik C, Hernández-Díaz. Medication use during pregnancy, with particular focus on prescription drugs: 1976–2008. Am. J Obstet Gynecol. 2011; 205(1): 51.e1–51.e8.

Bonati M, Bortolus R, Marchetti F, Romero M, Tongnoni G. Drug use in pregnancy: an overview of epidemiological (drug utilisation) studies. Eur. J. Clin. Pharmacology. 1990; 38(4): 325–328.

Rubin JD, Ferencz C, Loffredo C. Use of prescription and non-prescription drugs in pregnancy: The Baltimore Washington Infant Study Group. J Clin Epid. 1993; 46(6): 581–589.

Tillet J, Kostich LM, Vande Vusse L. Use of over-the-counter medications during pregnancy. J. Perinate Neonatal Nurse. 2003; 17(1): 3–18.

Sachdeva P, Patel BG, Patel BK. Drug use in pregnancy; a point to ponder! Indian J Pharm Sci. 2009; 71(1): 1–7.

Buitendijk, Bracken. Medication in early pregnancy: prevalence of use and relationship to maternal characteristics. Am J. Obstet Gynecol. 1991; 165(1): 33–40.

Das B, Sarkar C, Datta A, Bohra S. A study of drug use during pregnancy in a teaching hospital in western Nepal. Pharmacoepidemiology and Drug Safety. 2003; 12(3): 221–225.

Burgoon JM, Selhub J, Nadeau M, Sadler TW. Investigation of the effects of folate deficiency on embryonic development through the establishment of folate deficient mouse model. Teratology. 2002; 65(5): 219–227.

Czeizel AE. Nutritional supplementation and prevention of congenital abnormalities. Curr. Opin. Obstet. Gynecol. 1995; 7(2): 88–94.

George L, Mills JL, Johansson AL, Nordmark A, Olander B, Granath F, Cnattingius S. Plasma folate levels and risk of spontaneous abortion. JAMA. 2002; 288(15): 1867–1873.

Bucher HC, Guyatt GH, Cook RJ, Hatala R, Cook DJ, Lang J, Hunt D. Effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia. JAMA. 1996; 275(14): 1113–1117.

Hofmeyr GJ, Atallah AN, Duley L. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. The Cochrane. 2003; 4(2): 184.

Levine RJ, Hauth JC, Curet LB, Sibai BM, Catalano PM, Morris CD, Der Simonian R, et al. Trial of calcium to prevent eclampsia. New England Journal of Medicine. 1997; 337(2): 69–76.

Schatz M. The efficacy and safety of asthma medications during pregnancy. Semin Perinatal. 2001; 25(3): 145–152.

McDonald CF, Burdon JG. Asthma in pregnancy and lactation. MJA. 1996; 165(9): 485–488.

Schatz M, Dombrowski MP, Wise R, et al. The relationship of asthma medication use to perinatal outcomes. J Allergy Clin Immunol. 2004; 113(6): 1040–1045.

Werler MM, Mitchell A, Shapiro S. First trimester maternal medication use in relation to gastroschisis. Teratology. 1992; 45(4): 361–367.

Werler MM, Sheehan JE, Mitchell A. Maternal medication use and risks of gastroschisis and small intestinal atresia. American Journal of Epidemiol. 2002; 155(1):26–31.

Black RA, Hill A. Over-the-counter medications in pregnancy. Am Family Physician. 2003; 67(12): 2517–2524.

Andaloro VJ, Monaghan DT, Rosenquist TH. Dextromethorphan and other N-methyl-D-aspartate receptor antagonists are teratogenic in avian embryo model. Pediatr Resp. 1998; 43(1): 1–7.

Bateman DN, Mc Elhatton PR, et al. A case control study to examine the pharmacological factors underlying ventricular septal defects in North of England. Eur. J. Clin. Pharmacology. 2004; 60(9): 635–641.

Marinez-Frias M-L, Rodriguez-Pinilla E. Epidemiologic analysis of prenatal exposure to cough medicines containing dextrometorphan: no evidence of human teratogenicity. Teratology. 2001; 63(1): 38–41.

Saxen I. Cleft palate and maternal diphenydramine intake. Lancet. 1974; 1(7874): 407–408.

Aselton P, Jick H, Milunsky A, Hunter JR, Stergachis A. First trimester drug use and congenital disorders. Obstet. Gynecol. 1985; 65(4): 451–455.

Brost BC, Scardo JA, Newman RB. Diphenhdramine overdose during pregnancy: lessons from the past. Am. J. Obstet Gynecolo. 1996; 175(5): 1376–1377.

Reuvers M. Drugs During Pregnancy and Lactation. Analgesics and Antiphlogistics. 3rd edition. Elsevier. 2001; 16–26.

Mc Elhatton PR, Garbis HM, Schaefer C. Drugs during pregnancy and lactation. Poisons and overdoses. 3rd edition. Elsevier. 2001. pp. 206–213.

Little BB, Gilstrap LC, Van Bevern TT. Drugs and Pregnancy. Opiate abuse during pregnancy. 2nd ed. Elsevier; 1997.

Folb P, Dukes MN. Drug safety in pregnancy. Elsevier Science. Publisher B.V (Biomedical Division) 1990; 31–33; 349–367.

Ericson A, Kallen B. Non-steroidal ant-inflammatory drugs in early pregnancy. Reproductive Toxicology. 2001; 15(4): 371–375.

Siu KL, Lee WH. Maternal diclofenac sodium ingestion and severe neonatal pulmonary hypertension. Journal of Paediatrics and Child Health. 2004; 40(3): 152–155.

Mital P, Garg S, Khuteta S, Mital P. Mefenamic acid in prevention of premature labour. JR Soc Health. 1992; 112(5): 214–216.

Broussard CN, Richter JE. Treating gastro-oesophageal reflux disease during pregnancy and lactation: what are the safest therapy options? Drug Safety. 1998; 19(4): 325–337.

Pasternak B, Hviid A. Use of proton-pump inhibitors in early pregnancy and risk of birth defects. The New England Journal of Medicine. 2010; 363(22): 2114–2123.

Lewis JH, Weingold AB. The use of gastrointestinal drugs during pregnancy and lactation: GI drug column. The American Journal of Gastroenterology. 1985; 80(11): 912–923.

Sicuranza GB, Figueroa R. Uterine rupture associated with castor oil ingestion. J. Matern Fetal Neonatal Med. 2003; 13(2): 133–134.

Tytgat GN, Heading RC, Muller-Lissner S, Kamm MA, Scholmerich J, Berstad A, et al. Contemporary understanding and management of reflux and constipation in the general population and pregnancy: a consensus meeting. Aliment Pharmacol. Ther. 2003; 18(3): 291–301.

Festin M. Nausea and vomiting in early pregnancy. BMJ Clinical Evidence. 2014; 1405.

Mengue SS, Schenkel EP, Dunacan BB, Schmidth MI. Drug use by pregnant women in six Brazilian cities. Rev Saude Publica. 2001; 35(5): 415–420.

Hale E, Pomeranz MJ. Dermatologic agents during pregnancy and lactation: an update and clinical review. International Journal of Dermatology. 2002; 41(4): 197.

Czeizel AE, Rockenbauer M, Sorensen HT, Olsen J. Augmentin treatment during pregnancy and the prevalence of congenital abnormalities: a population-based case-control teratogenic study. Eur J Obstetrics & Gynaecology and Reproductive Biology. 2001; 97(2): 188–192.

Kanoh S, Rubin BK. Mechanisms of action and clinical application of macrolides as immunomodulatory medications. Clin Microbiol Rev. 2010; 23(3): 590–615.

Parnham MJ, Erakovic V, et al. Azithromycin: mechanisms of action and their relevance for clinical applications. Pharmacol Ther. 2014; 143(2): 225–245.

Gautret P, Lagier J-C, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020; 56(1): 105949.

Cooper WO, Hernandez-Diaz S, Arbogast PG, Dudley JA, Dyer SM, Gideon PS, et al. Antibiotics potentially used in response to bioterrorism and the risk of major congenital malformations. Paediatr Perinat Epidemiol. 2009; 23(1): 18–28.

Czeizel AE, Toth M, Rockenbauer M. No teratogenic effect after clotrimazole therapy during pregnancy. Epidermology. 1999; 10(4): 437–440.

Hassan SA, Elashheb MS, Ben-Rabha FM, Saeed NM, Ben Saad LA. Fetal outcome following maternal treatment with antiepileptic drugs. SAS J. Med. 2017; 3(6): 135–139.


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