Critical Analysis of Drug-Drug Interactions and Contraindications in Prescriptions of Pregnant Women; Findings from Lahore Pakistan

The careful evaluation of drug use during pregnancy is crucial due to its implications for both the mother and the unborn child's health and well-being. However, Pakistan lacks essential information regarding medication usage during pregnancy, posing significant challenges in ensuring the safety of maternal-fetal health. This study, set to take place in Lahore's tertiary care facilities, aims to analyze prescriptions for possible drug-drug interactions (DDIs) and contraindications. It's imperative to tackle the public health risks linked with prescribing medications during pregnancy to improve patient safety. The study was conducted on pregnant women visiting tertiary care government hospitals in Lahore. The data was collected through consecutive sampling from (15-08-2023 to 15-11-2023). A total of 109 prescriptions were collected. The data was analyzed using SPSS for statistical analysis. In a clinical trial involving patients aged between 26 and 30 years, 109 prescriptions revealed diverse levels of drug-drug interactions (DDIs), with 58 interactions documented. The majority of DDIs were classified as minor (21.1%) or moderate (15.6%), except for a single prescription containing severe DDIs. Benefits include comprehensive prescription evaluations and insights into potential hazards, while drawbacks may involve possible bias and challenges in FDA categorization. Overall, the study highlights the significance of assessing medications for pregnant women and enhancing prescription protocols.

1. Bajracharya N, Swaroop AM, Rajalekshmi SG, Viswam SK, Maheswari E. Incidence of drug-drug interactions among patients admitted to the department of general medicine in a tertiary care hospital. J Young Pharm. 2018;10(4):450.
2. Rana T, Farooq U, Kaur N, Khan A, Khan A. Plants derived efflux pump inhibitors: An approach against Multidrug-Resistant Gram-negative bacteria Klebsiella pneumoniae. Pharmacophore. 2023;14(1):71-9. doi:10.51847/7FQXFNYnT5
3. Odeh LGH, Jammal LE, Alenazi AA, Ansari SH. Factors affecting the prognosis of dental implants; A systematic review. Ann Dent Spec. 2024;12(2):39-46. doi:10.51847/w0q1mO1V2r
4. Farooqui R, Hoor T, Karim N, Muneer M. Potential drug-drug interactions among patients prescriptions collected from medicine out-patient setting. Pak J Med Sci. 2018;34(1):144.
5. Saurabh MK, Kumar S, Maharshi V. Evaluation of medicine exposure during pregnancy at a tertiary center of an Indian State. Maedica. 2020;15(4):503.
6. Mohammed MR, Ahmed MM. Estimation of the role of different staining protocols on micronucleus test accuracy in gamma-irradiated rats. J Biochem Technol. 2024;15(1):27-32. doi:10.51847/M92rn4BDIT
7. Belete TM, Mengesha E, Dandena A, Simegn W, Mengesha AK, Basazin A. Prescription pattern and associated factors among pregnant women attending antenatal clinics in University of Gondar, North West Ethiopia. Heliyon. 2022;8(12).
8. Marwa KJ, Njalika A, Ruganuza D, Katabalo D, Kamugisha E. Self-medication among pregnant women attending antenatal clinic at Makongoro health centre in Mwanza, Tanzania: A challenge to health systems. BMC Pregnancy Childbirth. 2018;18(1):1-8.
9. Höglund A, Wieslander KN, Frygner-Holm S, Godskesen T. Investigating the effectiveness of play therapy on reducing despair and anxiety in children with cancer. Clin Cancer Investig J. 2024;13(3):8-12. doi:10.51847/F9hI7g5UlG
10. Tuha A, Gurbie Y, Hailu HG. Evaluation of knowledge and practice of pharmacy professionals regarding the risk of medication use during pregnancy in Dessie town, northeast Ethiopia: A cross-sectional study. J pregnancy. 2019;2019(1):2186841.
11. Ismail M, Noor S, Harram U, Haq I, Haider I, Khadim F, et al. Potential drug-drug interactions in outpatient department of a tertiary care hospital in Pakistan: A cross-sectional study. BMC Health Serv Res. 2018;18:1-7.
12. Gutiérrez-Ramírez JA, Betancourt-Galindo R, Aguirre-Uribe LA, Cerna-Chávez E, Sandoval-Rangel A, Ángel EC, et al. Studying the insecticidal effect of titanium oxide nanoparticles on the periplaneta Americana. Entomol Appl Sci Lett. 2024;11(1):40-7. doi:10.51847/OUUOpwl7Er
13. Khan MSH. Evaluation of pregnant and lactating women's prescriptions for drug-drug interactions (DDI) and contraindications. medRxiv. 2022:2022-10.
14. Wilton L, Pearce G, Martin R, Mackay F, Mann R. The outcomes of pregnancy in women exposed to newly marketed drugs in general practice in England. BJOG: Int J Obstet Gynaecol. 1998;105(8):882-9.
15. Singar FAW. Characterization of defatted cake prepared from egyptian olive's fruit (Wateeken Cultivar) and its biological activity. World J Environ Biosci. 2024;13(2):31-5. doi:10.51847/R7K4g1FOdt
16. Zaidi SF, Mgarry R, Alsanea A, Almutairi SK, Alsinnari Y, Alsobaei S, et al. A Questionnaire-based survey to assess the level of knowledge and awareness about drug–food interactions among general public in Western Saudi Arabia. Pharmacy. 2021;9(2):76.
17. Lupattelli A, Spigset O, Twigg MJ, Zagorodnikova K, Mårdby AC, Moretti ME, et al. Medication use in pregnancy: A cross-sectional, multinational web-based study. BMJ Open. 2014;4(2):e004365.
18. Mohammed MA, Ahmed JH, Bushra AW, Aljadhey HS. Medications use among pregnant women in Ethiopia: A cross sectional study. J Appl Pharm Sci. 2013;3(4):116-23.
19. Trønnes JN, Lupattelli A, Nordeng H. Safety profile of medication used during pregnancy: Results of a multinational European study. Pharmacoepidemiol Drug Saf. 2017;26(7):802-11.
20. OghenemaroEnwa F, Amaihunwa KC, Adjekuko CO, Uti BC. Incidence of parasitic infections among individuals living in rural areas of delta state: Abraka communities. Int J Pharm Res Allied Sci. 2024;13(1):56-61. doi:10.51847/MEGAWekcJc
21. Shields KE, Lyerly AD. Exclusion of pregnant women from industry-sponsored clinical trials. Obstet Gynecol. 2013;122(5):1077-81.
22. Rockenbauer M, Olsen J, Czeizel AE, Pedersen L, Sørensen HT. Recall bias in a case-control surveillance system on the use of medicine during pregnancy. Epidemiology. 2001;12(4):461-6.
23. Bánhidy F, Lowry RB, Czeizel AE. Risk and benefit of drug use during pregnancy. Int J Med Sci. 2005;2(3):100.
24. Gautam CS, Saha L, Sekhri K, Saha PK. Iron deficiency in pregnancy and the rationality of iron supplements prescribed during pregnancy. Medscape J Med. 2008;10(12):283.
25. Martínez‐Shaw ML, Sánchez‐Sandoval Y. Studying the effectiveness of mindfulness intervention on the stress of mothers with premature infants. J Integr Nurs Palliat Care. 2024;5:48-54. doi:10.51847/YRsdPlmIDO
26. Johnell K, Klarin I. The relationship between number of drugs and potential drug-drug interactions in the elderly: A study of over 600 000 elderly patients from the Swedish prescribed drug register. Drug Saf. 2007;30:911-8.
27. Ragam Jr AS, Sheela S. Prevalence of potential drug-drug interactions among hypertensive pregnant women admitted to a tertiary care hospital. Cureus. 2023;15(3).
28. Sachdeva P, Patel B, Patel B. Drug use in pregnancy; A point to ponder! Indian J Pharm Sci. 2009;71(1):1.
29. Prichard M, Shipman Jr C. A three-dimensional model to analyze drug-drug interactions. Antiviral Res. 1991;15:114.
30. Moore N, Pollack C, Butkerait P. Adverse drug reactions and drug–drug interactions with over-the-counter NSAIDs. Ther Clin Risk Manag. 2015:1061-75.
31. Sheffield JS, Siegel D, Mirochnick M, Heine RP, Nguyen C, Bergman KL, et al. Designing drug trials: Considerations for pregnant women. Clin Infect Dis. 2014;59(suppl_7):S437-44.