This document presents the findings of a study on the knowledge of pharmacists in India regarding the risks of medication use during pregnancy. It surveyed 350 pharmacists using a questionnaire about the safety of various prescribed, over-the-counter, dietary supplement and herbal medications in pregnancy. The results found that pharmacists had good knowledge about some risks, such as the dangers of tetracycline and valproic acid, but gaps in knowledge remained for other medications like alprazolam and herbal supplements. The study concludes that while pharmacists play an important role in counseling pregnant women, further educational interventions are still needed to improve their medication safety knowledge during pregnancy.

1. Teegala Ram Reddy College of Pharmacy
A STUDY ON KNOWLEDGE OF PHARMACIST ON
RISK OF MEDICATION USE DURING PREGNANCY
IN INDIA
A STUDY ON KNOWLEDGE OF PHARMACIST ON
RISK OF MEDICATION USE DURING PREGNANCY
IN INDIA
1
Under the guidance of:
Ms .C. Anamika, M.Pharm.,
Department of Pharmacology.
Presented by:
V. Sunil Kumar
V. Prashanth Naik
Y.Prema Swarupa
Zahuruddin Mohd

2. Contents:
 Introduction
 Aim & Objectives
 Literature Review
 Plan of Work
 Materials & Methods
 Results
 Drugs That Cause Problems
Conclusion
 References
2

3.  Pregnancy, also known as gestation, is the time
during which one or more offspring develops inside
a woman.
 A multiple pregnancy involves more than one
offspring, such as with twins.
 Childbirth typically occurs around 40 weeks from
the last menstrual period (LMP).
 This is just over nine months, where each month
averages 29½ days. When measured from conception it is
about 38 weeks. 3
Introduction:

4. Stages of Pregnancy:
Pregnancy is typically divided into three
trimesters.
1. First Trimester (From week 1 to 12)
2. Second Trimester (Week 13 to 28)
3. Third Trimester (Week 29 to 40)
4

5. 1.First Trimester:
The first trimester is from week 1 to 12 and includes
conception. Conception is when the sperm fertilizes the egg.
The fertilized egg then travels down the fallopian tube and
attaches to the inside of the uterus, where it begins to form
the embryo and placenta.
5

6. Second Trimester:
The second trimester is from week 13 through
28. Around the middle of the second trimester, movement of
the fetus may be felt. At 28 weeks, more than 90% of babies
can survive outside of the uterus if provided with high-quality
medical care.
6

7. 3.Third Trimester:
7
The third trimester is from 29 weeks through 40
weeks.

8.  Tiredness
 Constipation
 Pelvic girdle pain
 Back pain
 Edema (swelling).
 Urinary tract infection
 Hemorrhoids (piles)
 Nausea
8
Signs and Symptoms:
Common symptoms and discomforts of
pregnancy include:

9. 9
Aim and Objective:
Aim:- To evaluate knowledge of CPs about the medication
safety during pregnancy.
Objective:- To improve medication use especially among
the pregnant women in their community

10. 10
Literature Review:
 Al-Arifi MN Et al Knowledge of community pharmacists
about the risks of medication use during pregnancy in central
region of Saudi Arabia. Community pharmacists (CPs) are
the most accessible health care provider to the public, and
they have huge duties to improve medication use especially
among the pregnant women in their community. The
objective of this study was to evaluate knowledge of CPs
about the medication safety during pregnancy.
 Alaqeel S, Abanmy NO. Et al Counseling practices in
community pharmacies in Riyadh, Saudi Arabia: a cross-
sectional study. Community pharmacists play a crucial role in
optimizing medication use and improving patient outcomes,
whilst preventing medication misuse and reducing costs.

11. 11
 Ravichandran A, Basavareddy A Et al Perception of
pharmacists regarding over-the-counter medication: A
survey. To assess knowledge, attitude, and practice of the
pharmacists toward dispensing the over-the-counter (OTC)
medications using questionnaire.
 You JH, Wong FY, Et al Public perception on the role of
community pharmacists in self-medication and self-care in
Hong Kong. The choices for self-medication in Hong Kong
are much diversified, including western and Chinese
medicines and food supplements.
 Al- Jazairi AS, Alharbi R Et al Assessment of evidence-
based practice among hospital pharmacists in Saudi Arabia:
attitude, awareness, and practice. Background Many studies

12. 12
have previously looked at the perceptions, attitude, and use
of Evidence-based Practice (EBP) among healthcare
providers.
 Shilbayeh SA Et al Exploring knowledge and attitudes
towards counseling about vitamin supplements in Jordanian
community pharmacies. The use of multivitamins within a
pharmaceutical setting has been the subject of considerable
debate. This research aimed to provide a platform for
assessing and evaluating knowledge, attitudes and
professional practices of Jordanian community pharmacists in
counseling patients about the safe consumption of vitamins.

13. 13
Plan of Work:
 Sponsor
 Protocol
 Study Design
 Patient Enrolment
 Subjects Inclusive and Exclusive Criteria
 ICF Collection
 Randomization
 Drug Treatment
 End of the Treatment
 Collection of Case Report Form
 Statistical Analysis
 Thesis Writing

14. 14
1. Questionnaire design:-
The first part is the demographic survey regarding
the age, number of working years’ experience in the
field of pharmacy, and practice asking female
patients about the pregnancy status.
 The second part comprised of a list of prescription
drugs, non-prescription drugs, dietary complements,
and herbal medicines.
The questionnaire composed of two main parts.
Materials & Methods:

15. 15
2. Study population:-
To calculate the sample size, we assumed 50% of
the pharmacists have good knowledge about drug safety
during pregnant women, and a total of 350 pharmacies
would provide a representative sample size with 5% margin
of errors and 95% confidence level.
3. Data analysis:-
The data was entered into the SPSS version 22 for
Windows (SPSS) for analysis. Both descriptive and
analytic statistics were utilized. For descriptive analysis,
results were expressed as numbers, percentages and mean
(±SD and 95% CI).

16. 16
Results:
 Responses were returned from 50 CPs given a
response rate of 71.1%. Demographic characteristics of
the participants are showed in Table 1.
 The age of approximately 71.5% of the study sample
ranges from 25 to 35 years. About 94.9% of the
participants have less than 10 years working experience
in the field of pharmacy.
 Of all included participants, 54.7% are asking their
female patients about the pregnancy status.

17. 17
Table-1
Demographic characteristics of the participants.(25)
Age Frequency Percentage (%)
From 25 to 35 18 71.5
From 36 to 45 7 27.3
From 46 to 55 - -
Years of working experience
Less than 10 years 24 94.9
From 20 to 30 years 1 4.3
From 31 to 40 years - -
Asking for Pregnancy Status
Always 14 54.7
Often 9 38.3
If she looks pregnant 1 6.6
Never - -

18. 18
 Table 2 presents the CPs’ response of drug safety
during pregnancy. Most of respondents (69.6%) believed
that alprazolam is not safe while 22% of respondents
believed that it is used on basis of risk-benefit
assessment. For central nerves system drugs, about 49%
of CPs identified valproic acid is not safe. For more
details see Table 2.
 Table 3 shows the CPs’ response to the use of OTC
drugs during pregnancy. About dietary supplements,
48.4% of CPs reported that Vitamin A supplements are
not safe. Most of CPs (76.9%) Bismuth is not safe for use
in the first trimester.

19. 19
Response of CPs to use of prescribed medications during pregnancy.
Medication Not safe in
the first
trimester
(%)
Must weigh
risks and
benefits for
individual
patients
(%)
Safe in the
first
trimester
(%)
I don’t
know
%
Alprazolam 69.6 22.3 2.3 5.50
Tetracycline 74.2 11.7 10.5 3.5
Valproic Acid 48.8 46.1 1.2 3.0
Amoxicillin 5.9 23.8 65.2 4.7
Contraceptive 67.2 22.7 2 6.3
Phenobarbital 50.4 44.1 0.8 3.5
Table-2

20. 20
Medication Not safe in
the first
trimester
(%)
Must weigh
risks and
benefits for
individual
patients (%)
Safe in the
first
trimester
(%)
I don’t know
%
Aspirin 2.7 55.1 36.7 5.5
Bismuth 46.9 27.7 20.7 4.7
Caffeine 6.30 22.6 66.4 39.0
Ibuprofen 56.6 18.4 9.0 15.6
Supplement
Vitamin A
48.4 18 5.9 26.2
Table-3
Response of CPs to use of over-the-counter (OTC) medications during
pregnancy.

21. Drugs That Cause Problems:
21
Anti-anxiety Drugs:
Benzodiazepines (Diazepam, Lorazepam)
Antibiotics:
Tetracycline, Trimethoprim
Anticoagulants:
Heparin, Warfarin
 It causes very slow breathing, irritability, & Shaking.
 Liver Failure, slowed bone growth
 Bleeding problems in fetus, Blood clot.
Ondansetron
 Heart Disease
Anti-emetic Drugs:

22. 22
Conclusion:
Community Pharmacists are the most accessible
health care providers who can help pregnant women with
their medications use. Although there are some areas
where pharmacists are knowledgeable about drug safety
during pregnancy, there are still gaps in knowledge where
educational interventions are needed.

23. 23
References:
1) Al - Arifi, MN, Saudi Pharmaceutical Journal: SPJ: the
Official Publication of the Saudi Pharmaceutical Society
[25 May 2017, 25(7):1093-1096]
2) Alaqeel S, Abanmy, Counseling practices in community
pharmacies in Riyadh, Saudi Arabia: a cross-sectional
study. BMC Health Serv Res. 2015; 15: 557. [PMC]
3) Ravichandran A, Basavareddy A. Perception of
pharmacists regarding over-the-counter medication: A
survey. Indian Journal of Pharmacology. 2016; 48(6):729-
732. doi:10.4103/0253-7613.194857.

24. 24
4) You JH, Wong FY, Chan FW, Wong EL, Yeoh E.
Public perception on the role of community pharmacists in
self-medication and self-care in Hong Kong. BMC
Clinical Pharmacology. 2011; 11:19. Doi: 10.1186/1472-
6904-11-19.
5) Engeland A, Bramness JG, Daltveit AK, Ronning M,
Skurtveit S, Furu K. Prescription drug use among fathers
and mothers before and during pregnancy. A population-
based cohort study of 106,000 pregnancies in Norway
2004–2006. Br J ClinPharmacol. 2008.
6) Lacroix I, Hurault C, Sarramon MF, et al. Prescription
of drugs during pregnancy: a study using EFEMERIS, the
new French database. Eur J ClinPharmacol. 2009.

25. 25
7) Al-Hassan M. Community pharmacy practice in Saudi
Arabia: an overview. Internet J. Pharmacol. 2011;9(1)
8) Arah, E.M.A.A.A., 2012. Community Pharmacists'
Medication Knowledge: A Nation-wide Study in Palestine.
Faculty of Graduate Studies Community Pharmacist.
9) Baldon J.P., Correr C.J., Melchiors A.C., Rossignoli P.,
Fernandez Llimos F., Pontarolo R. Community pharmacists’
attitudes and knowledge on dispensing drugs to pregnant
women. Pharm. Pract. 2006;4(1):38–43.
10) George J. Optimising medication use during pregnancy:
the potential role of pharmacists. Int. J. Pharm.
Pract. 2011;19:81–83.

26. 26