(248) Adverse Birth Outcomes Associated with Drug Use in Pregnancy at a Referral Teaching Hospital in Kenya

Publication Number: 579

Background: Drug use during pregnancy is common and essential for treating a pre-existing condition or a condition developing during pregnancy. In Kenya, there has been an increase in cases of adverse birth outcomes ( ADBOs) including preterm births, congenital malformations and stillbirths.

Objectives: To determine association between adverse birth outcomes and medication used during pregnancy among mothers who delivered at the Kenyatta National Hospital.

Methods: A comparative cross-sectional study to compare medication use during pregnancy in mothers who had normal infants and those with ADBOs. The study site was the Kenyatta Hospital (KNH) which is the national tertiary, teaching and referral hospital in Kenya. The target population were mothers who delivered between April to July 2019. Mothers were included in the study if they had a singleton delivery of a normal infant or an adverse birth outcome, had attended antenatal clinic and consent to participate in the study. Mothers with multiparous births or postnatal referrals were excluded. Data was collected through structured, interviewer administered questionnaire and review of medical records. to document ADBOs such as preterm, birth defects or still births as well as the medications used during pregnancy. Descriptive statistics and multivariable logistic regression was conducted to assess the relationship between medication use and birth outcomes. The study was approved by the Institutional Review Board and the Hospital management.

Results: A total of 2360 deliveries were reported between April and July 2019 of which 340 were recruited into the study consisting of 170 mothers with normal infants and 170 mothers with ADBOs. Majority of mothers with ADBOs had babies below 2.5g (136 (80%) compared to mothers with normal infants (12 (7.1). Preterm birth was the most common ADBO at 47 (27.6%) followed by stillbirth 26 (15.3%) and congenital malformations 12 (7.14%). Majority 164 (48.4%) of the mothers received drugs from FDA Pregnancy Risk category A. More mothers with ADBOs 24 (13.9%) received FDA category D drugs compared to those with normal infants 15 (8.7%). The risk of developing ADBOs increased 6-fold with the use of nifedipine (OR 6.42, P < 0.001), 4-fold with carbamazepine (OR3.97, P = 0.012) and 3-fold with magnesium sulphate (OR 3.11, P = 0.016) after adjusting for confounding.

Conclusions: Preterm birth was the most common ADBO among pregnant mothers delivering at the Kenyatta National Hospital. Most pregnant mothers are exposed to medications during pregnancy and were at risk of ADBOs. Prescribing medication to pregnant women should be carefully evaluated and measures put in place to monitor and prevent the potential known and unknown medication related risks to the developing fetus.