Abstract：
Background: Individuals with disabilities may require specific medications in pregnancy. The prevalence and patterns of medication use, overall and for medications with known teratogenic risks, are largely unknown. Methods: This population-based cohort study in Ontario, Canada, 2004-2021, comprised all recognized pregnancies among individuals eligible for public drug plan coverage. Included were those with a physical (n = 44,136), sensory (n = 13,633), intellectual or developmental (n = 2,446) disability, or multiple disabilities (n = 5,064), compared with those without a disability (n = 299,944). Prescription medication use in pregnancy, overall and by type, was described. Modified Poisson regression generated relative risks (aRR) for the use of medications with known teratogenic risks and use of ≥2 and ≥5 medications concurrently in pregnancy, comparing those with versus without a disability, adjusting for sociodemographic and clinical factors. Results: Medication use in pregnancy was more common in people with intellectual or developmental (82.1%), multiple (80.4%), physical (73.9%), and sensory (71.9%) disabilities, than in those with no known disability (67.4%). Compared with those without a disability (5.7%), teratogenic medication use in pregnancy was especially higher in people with multiple disabilities (14.2%; aRR 2.03, 95% confidence interval [CI]: 1.88-2.20). Furthermore, compared with people without a disability (3.2%), the use of ≥5 medications concurrently was more common in those with multiple disabilities (13.4%; aRR 2.21, 95% CI: 2.02-2.41) and an intellectual or developmental disability (9.3%; aRR 2.13, 95% CI: 1.86-2.45). Interpretation: Among people with disabilities, medication use in pregnancy is prevalent, especially for potentially teratogenic medications and polypharmacy, highlighting the need for preconception counseling/monitoring to reduce medication-related harm in pregnancy.
摘要：
背景：残疾人士在怀孕期间可能需要特定的药物治疗。药物使用的流行和模式，总体和已知致畸风险的药物，基本上是未知的。方法：这项基于人群的队列研究在安大略省，加拿大,2004-2021年，包括有资格获得公共药物计划覆盖的个人中所有公认的怀孕情况。包括那些有身体检查的人(n=44,136)，感官(n=13,633)，智力或发育(n=2,446)残疾，或多重残疾(n=5,064)，与没有残疾的人相比(n=299,944)。怀孕期间使用处方药，总体和类型，被描述。改良泊松回归产生了使用已知致畸风险的药物和在怀孕期间同时使用≥2种和≥5种药物的相对风险（aRR）。比较那些有残疾和没有残疾的人，调整社会人口统计学和临床因素。结果:妊娠期用药在有智力或发育的人群中更为常见(82.1%),倍数（80.4%），实物（73.9%），和感觉障碍(71.9%)，比那些没有已知残疾的人(67.4%)。与无残疾人士(5.7%)相比，妊娠期致畸药物的使用率在有多重残疾的人群中尤其高(14.2%;aRR2.03,95%置信区间[CI]:1.88-2.20).此外，与无残疾人士(3.2%)相比，多残疾患者(13.4%;aRR2.21,95%CI:2.02~2.41)和智力或发育障碍患者(9.3%;aRR2.13,95%CI:1.86~2.45)同时使用≥5种药物更为常见.解释：在残疾人中，怀孕期间的药物使用很普遍，特别是潜在的致畸药物和多重用药，强调需要进行孕前咨询/监测，以减少怀孕期间与药物相关的伤害。
