by Awa Sowe
Pregnancy is one of the most important events that constitute a powerful experience in the lives of women and their families. Although pregnancy is a normal physiological process, it has health risks for the women and the newborns
Globally, complications during pregnancy, childbirth, and the postnatal period have been the leading causes of death and disability among reproductive age women, as a result, 10.7 million maternal deaths are reported to occur before the age of 25 years globally.
Thus, 2.7 million neonatal deaths and 2.6 million stillbirths were reported in the world from 1990 to 201. Additionally, nearly 99% of the maternal deaths occurred in low- and middle-income countries, particularly in South Asia and Sub-Saharan Africa. Although the proportion of women attending prenatal care was satisfactory. The quality of prenatal care has an important role in the prevention, monitoring, early detection, and treatment of maternal health problems, enhancing maternal satisfaction, and healthcare utilization.
Pregnant women experience various symptoms during pregnancy Some medications are used during pregnancy to treat various symptoms and diseases. Some women with previously diagnosed medical conditions such as asthma, diabetes mellitus, or any autoimmune disease such as systemic lupus should continue the prescribed medications to avoid adverse pregnancy outcomes, including stillbirth, low birth weight, or preeclampsia
In an interview with midwife, Sainabou Cham, she said that non-compliance to antenatal medication as well as its adverse effects is a commonly encountered problem in developing countries. She referenced a report that indicated that the compliance of pregnant women to antenatal medication in developing countries was as low as 28.7%. “It has also been found that about 58 million women in developing countries are anemic during pregnancy and this situation was likely the result of non-compliance of the pregnant women with antenatal medication”.
According to Cham, in line with the recommendations, at each antenatal visit in most developing countries, prenatal medication is prescribed and given to the pregnant women throughout their gestational period. These medications and supplements include iron, folic acid, vitamin B complex, vitamin C, malaria drug for prophylaxis, tetanus toxoid immunisation.
“Using medication during pregnancy is a concern for most pregnant women, either over the counter or prescribed medications. Understanding these concerns may lead to achieving the best counseling for pregnant women, resulting in better adherence to their medications and preventing negative outcomes” she noted.
She went on to explain that some typical barriers influencing medication compliance in pregnancy include expected side effects from the medication, taste of the drug, forgetfulness, disappearance of the complaints for which the medication was prescribed, fear of having a big baby, etc.
Madam Cham further explained that educational status of pregnant women can also influence how pregnant women view the use of medications, but the outcomes are diverse. “For example, a study conducted showed that higher-educated women were more hesitant to take any medication during pregnancy. In contrast, less-educated women believed that pharmaceuticals, in general, were hazardous and herbal medicines were safe”.
She added that high prevalence of herbal medicine use during pregnancy in the country is influenced by local cultural practices. The majority of women believed that moderate use of herbal medications would not cause any harm to the mother or the fetus.
However, she went on to explain that, society believes excessive use of pregnancy care pills would result in unfavorable outcomes such as stillbirth, early labor, infant abnormalities, and long-term repercussions on maternal health.
She further explained that,although it is argued that diet alone, if sufficiently fortified, can meet nutritional demands during pregnancy, many women, especially in low- and middle-income countries, have inadequate diets that are lacking in nutrients and micronutrients necessary for maintaining good health. She went on to explained that These deficiencies become more evident during gestation as the baby makes its own demands via the placenta. The exacerbation of the nutrient deficiency can influence the overall health of both mother and foetus and may result in adverse effects.
she added that Intermittent preventive treatment of malaria during pregnancy (IPTp) is a preventive regimen of the antimalarial drug sulfadoxine-pyrimethamine (SP) given monthly to all at-risk pregnant women in their second and third trimesters. Each dose treats existing malaria infection in the mother and may protect against new infections for several weeks after receipt.
“IPTp has mixed evidence of effectiveness for the outcomes we consider most relevant, reducing malaria infections in pregnant women and reducing low birthweight in infants. Specifically, its benefits may be limited to a relatively small proportion of treated women. IPTp appears to be effective at reducing malaria infections and anemia in pregnant women, and reducing low birthweight in infants” she posited.
Globally, iron-deficiency anaemia is the commonest micronutrient deficiency, the prevalence of anaemia in pregnancy was 38% worldwide, which is equivalent to 32 million pregnant women in the world. She added that, it was also noted that West Africa, Central Africa and Asia account for the majority of these women. The adverse events associated with deficiency of iron and other nutrients required for normal metabolism and health of the mother and foetus contribute to maternal mortality.
Considering the importance of adequate nutrients to both the mother and the child, it is necessary for pregnant women to supplement their diet with vitamins in order to meet the daily recommended amounts of micronutrients. She went on to explained that as part of routine prenatal care, the World Health Organization recommends iron and folic acid supplements, micronutrient and supplements and studies have shown that have shown that babies born to mothers who do not comply with the taking of antenatal medications are more likely to be born prematurely (before the 37th week of pregnancy), have a low birthweight, have problems with iron levels and a poorer performance in mental ability tests; they are also at increased risk of infection, heart and lungs problems, restless leg syndrome, etc.
Madam Mariama Ceesay Jallow, a pregnant woman currently doing her routine prenatal care visits at the Serrekunda General Hospital, said that she does her visit regularly and drinks all prescribed medication except “Fansida”.
She mentioned that the drug passes dizziness and headache with high fever to her, and that that she took only two doses but the experience was not so pleasant.
Mrs Awa Secka, a nursing mother said that during her pregnancy and prenatal routine she took all her prescribed medications. Although some came with side effects, she said, she took doctor’s advice and cooperated.
She added that the drugs prevent her from some diseases and infection and help her with a save natural delivery.
Good compliance with antenatal medication increases a pregnant woman’s chance of giving birth normally and helps to achieve a global reduction in maternal and child morbidity and mortality. Compliance, in this regard, refers to the extent to which the behavior of the patient coincides with medical or health advice.
Occurrence of side effects and maternal age are also major factors that influence compliance to prenatal routine and use of medications in our setting. It is important to intensify communication for behavioral change and counseling before or during prenatal consultations. This could promote the compliance of pregnant women with the preventive treatment of diseases such as anemia and its complications. Women should be counseled thoroughly on the side effects as well as the importance of these drugs during pregnancy so as to improve adherence. They should also be advised to keep their medications in a place where they can easily see them, since forgetfulness is the major reason for not taking the tablets.
