Estimating the Prevalence of Prescribed Medication Use in Pregnancy with a Systematic Review and Meta-analysis

Medication use in pregnancy is common, but decisions balancing the needs of maternal and fetal health can be complex. Ongoing monitoring of medication use in pregnancy is essential to ensure their continued safe and appropriate use in this population.

The aim of this review is to estimate the prevalence of prescribed medication use in pregnancy.

This review was carried out in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol was registered in the PROSPERO database (CRD42024533866). PubMed, Medline, Cinahl (EBSCO), APA PsychINFO (EBSCO), Embase (Ovid), Scopus, and Web of Science databases were systematically searched for relevant articles published from January 2010 to May 2025. Inclusion criteria specified that studies provided a value for prescribed medication use in the general population of pregnant women during part or all of the gestational period. Articles were independently dual screened, and relevant data were extracted and validated from included studies. Quality and bias of the studies were assessed using the Joanna Briggs Institute critical appraisal tool for prevalence studies. A narrative synthesis was conducted for all studies. A random-effects meta-analysis with logit transformation was used to pool prevalence estimates (95% confidence interval, CI) where sufficient studies defined medication use in a similar way. Cochran's Q, I², and τ² were used to measure heterogeneity.

A total of 13,416 unique articles were identified and screened. Seventy studies were included. The pooled prevalence for prescribed medication alone during pregnancy was 56% (CI 44-67%, p < 0.01, I² = 100%, τ² = 1.30), based on 23 studies and a population of 7.3 million. The pooled prevalence for prescribed medications alone for the first, second, and third trimesters was 31% (CI 22-40%, p < 0.01, I² = 100%, τ² = 0.65) from 14 studies, 30% (CI 21-42%, p < 0.01, I² = 100%, τ² = 0.56) from 9 studies, and 34% (CI 22-49%, p < 0.01, I² = 100%, τ² = 0.77) from 8 studies, respectively. The pooled prevalence for prescribed medications including prescribed vitamins and minerals was 83% (CI 75-89%, p < 0.01, I² = 100%, τ² = 1.66) based on 26 studies and a population of 4.9 million. For this more inclusive group, the pooled prevalence for the first, second, and third trimesters was 52% (CI 44-61%, p < 0.01, I² = 100%, τ² = 0.46) from 14 studies, 56% (CI 42-70%, p < 0.01, I² = 100%, τ² = 0.88), and 59% (CI 42-74%, p < 0.01, I² = 100%, τ² = 1.25) both from 10 studies, respectively. Methods used to estimate prevalence varied greatly owing to differences in the definition of prescribed medications, the measured exposure period, and the pregnancy outcomes included.

From this review, it was evident that a large proportion of women use prescribed medications during pregnancy, but estimates vary greatly. A more standardized approach to studying medication use in pregnancy is needed to allow for consistent and standardised estimates that are comparable across populations.