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Title: Prescription drug use in lactating mothers: an experience at a referral hospital and in a community in India.
Author: Uppal R, Karmakar S, Singh MM, Dhall GI, Gupta I, Sharma PL.
Journal: Int J Clin Pharmacol Ther Toxicol; 1993 Feb; 31(2):93-5. PubMed ID: 8458682.
Abstract:
The aim of the study was to investigate the extent of prescription drugs administered for common disorders during the post partum period. This is a prospective survey of disorders and drug use in 1) immediate postpartum mothers (n = 200) admitted to the maternity wards, 2) in post-natal hospital follow-up clinic (n = 200) and in 3) the rural home based community (n = 100). A pretested questionnaire was filled in by medical officers after interviewing the mothers. The mean age of the mothers was 25 years and a literacy rate of 50% above the 10th grade. Over 80% of the women were multigravida in the entire sample; 45% underwent Caesarean Section in a hospital; 97.6% had a normal delivery in the community. In the hospital settings 4.1% infants had jaundice and 1% had congenital anomalies. In the community setting, diarrhoea and pneumonia was seen in 2.6% of the infants. Apart from the use of nutritional supplements, such as iron, calcium, multivitamins etc., most commonly prescribed drugs were analgesics (in 70% of patients in the hospital settings, 56% of the patients in the postnatal clinic and 37.6% patients in the community), and antibiotics (90% of the patients in the hospital settings, 86% of the patients in the postnatal clinic and 13% of the community based patients). Antihypertensives agents (2.5% of the patients), digoxin (1.5% of the patients), bronchodilators (1% of the patients) and sedatives (3.5% of the patients) were prescribed to admitted patients.(ABSTRACT TRUNCATED AT 250 WORDS) Between November 1989 and May 1990 in India, interviewers spoke to 200 postpartum women shortly after having delivered in Nehru Hospital, to 200 women attending the postnatal clinic at the same hospital, and to 100 postpartum women living in a rural area, all of whom were lactating, to examine the pattern of prescription drug use for disorders common during the postpartum period. 97% of deliveries in the community sample were normal deliveries while this figure for the hospital sample was only 44%. The most common disorders mothers experienced included backache (30% for community, 22% for immediate postpartum, and 5% for postnatal clinic), fever (18%, 22%, and 11%, respectively), and stitch pain (0, 6%, and 2.5% respectively), while those among the infants were diarrhea (1% community and 5% postnatal) and pneumonia (1% community). 90% of the lactating mothers received 1 prescription drug. 5% took chronic medication throughout pregnancy and breast feeding. The major predictive variable to drug use was delivering in the hospital and/or attending its postnatal clinic, e.g., 86-90% of these mothers received antibiotics and 57-70% received analgesics. The corresponding percentages for the community sample were 13% and 37%. The leading prescription drugs were nutritional supplements (e.g., iron supplement = 84.96% for hospital samples), analgesics, and antibiotics. Other drugs were administered only to the hospitalized mothers and included sedatives (7%), antihypertensive (5%), digoxin (3%), and bronchodilators (2%). Many women, especially those in the community sample, avoided certain foods during lactation for cultural and social reasons (e.g. lentils). 17% of the hospitalized mothers, 17% of those attending the postnatal clinic, and 4% of those in the community sample were concerned about taking drugs while breast feeding. Most received no information on prescription drug use and all wanted correct information about the drug. 62-90% wanted verbal information.

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