Srinivas College of Pharmacy, Valachil, Farangipete, Mangalore, Karnataka, India 574143
Safe medication use during pregnancy is essential for maternal and fetal health. Inadequate awareness often leads to inappropriate self-medication and poor practices. This study aimed to assess the impact of a pharmaceutical care intervention on knowledge, attitude, and practice (KAP) regarding medication use during pregnancy. A hospital-based prospective interventional study was conducted over six months at a tertiary care hospital in Dakshina Kannada, Karnataka. One hundred pregnant women with gestational diabetes mellitus (GDM) were screened; 50 with poor KAP scores were included and randomized into intervention (n=25) and control (n=25) groups. The intervention group received patient information leaflets (PIL) and pharmacist counseling, while the control group received standard care. Pre- and post-intervention KAP scores were assessed using a validated questionnaire. Results showed significant improvement in the intervention group post-intervention: misconceptions about medication safety reduced from 68% to 24% (p<0.001), positive attitudes toward consulting physicians and pharmacists increased from 16% to 80% (p<0.001), and safe practices such as avoiding self-medication improved from 76% to 12% (p<0.001). No significant changes were observed in the control group. This study concludes that structured pharmacist-led educational interventions significantly improve knowledge, attitudes, and practices regarding medication use during pregnancy. Incorporating pharmaceutical care into antenatal programs can enhance safe medication practices and maternal outcomes.
Medication use during pregnancy is a matter of critical importance, as inappropriate practices can lead to adverse maternal and fetal outcomes. Pregnant women often overestimate the teratogenic risk of drugs, resulting in reluctance to take prescribed medicines, or conversely may use non-prescribed drugs due to poor awareness.¹ Safe prescribing during pregnancy therefore requires not only clinical judgment but also patient education to correct misconceptions.
Knowledge, Attitude, and Practice (KAP) studies provide insights into existing gaps, misconceptions, and behaviors regarding drug use.² They also help in designing educational interventions aimed at improving rational drug use. Previous studies across India and globally have reported variable knowledge levels among pregnant women, with significant proportions relying on self-medication.³??
Pharmaceutical care interventions by clinical pharmacists, including structured counseling and patient information leaflets (PILs), have been shown to improve knowledge and adherence in chronic diseases.? However, limited research exists on their role in improving KAP regarding medication use during pregnancy in the Indian setting.
Hence, the present study was undertaken to evaluate the impact of a pharmaceutical care intervention on KAP regarding medication use among pregnant women with gestational diabetes mellitus (GDM).
MATERIALS AND METHODS
Study Design and Setting
A hospital-based, prospective interventional study was conducted for six months at a tertiary care hospital in Dakshina Kannada, Karnataka.
Ethical Approval
The study protocol was approved by the Institutional Ethics Committee (Ref No: SIEC/SIMS & RC/53/03/2024). Written informed consent was obtained from all participants.
Participants
Pregnant women aged ≥18 years, diagnosed with GDM, were eligible. Women with psychiatric illness, pre-existing diabetes, or unwilling to consent were excluded.
Sample Size and Grouping
Out of 100 screened, 50 with poor baseline KAP scores were included. They were divided equally into control (n=25) and intervention (n=25) groups.
Intervention
The intervention group received structured pharmacist counseling and a patient information leaflet (PIL) focusing on safe medication practices in pregnancy. The control group received routine care.
Data Collection Tool
A validated KAP questionnaire was used. Scores ≥6 indicated good KAP, while <3 indicated poor KAP.
Statistical Analysis
Data were analyzed using Microsoft Excel. Pre- and post-intervention scores were compared using Chi-square and unpaired t-tests. A p-value <0.05 was considered statistically significant.
RESULTS
Baseline KAP Scores:Out of 100 women screened, 50 had good KAP and were excluded; 50 with poor KAP were randomized equally.
Table 1: Distribution of subject based on KAP score
|
KAP |
N=100 |
|
GOOD KAP SCORE |
50 |
|
POOR KAP SCORE |
50 |
Knowledge: Before intervention, 68% of women believed any medication could be used at any stage of pregnancy. This reduced to 24% post-intervention (p<0.001). Understanding about risks of non-prescribed medication use improved from 32% to 76%.
Table 2. Knowledge of study participants on medication use during pregnancy
|
Questions |
Response |
Intervention group n=25 |
Control group n=25 |
P value |
||
|
|
|
PRE |
POST |
PRE |
POST |
|
|
Any medication can be used atany stage of pregnancy |
Yes |
17(68%) |
6(24%) |
18(72%) |
17(68%) |
<0.00001 |
|
No |
8(32%) |
19(76%) |
7(28%) |
8(32%) |
||
|
Some medications may be more suitable to be used during some stage of pregnancy |
Yes |
4(16%) |
21(84%) |
5(20%) |
8(32%) |
<0.00001 |
|
No |
21(84%) |
4(16%) |
20(80%) |
17(68%) |
||
|
A non-prescribed medication can be used during pregnancy |
Yes |
17(68%) |
6(24%) |
16(64%) |
14(56%) |
<0.00001 |
|
No |
8(32%) |
19(76%) |
9(36%) |
11(44%) |
||
|
Wrong drug choice can affect the formation of the fetus and health of the mother |
Yes |
13(52%) |
19(76%) |
7(28%) |
7(28%) |
<0.00001 |
|
No |
12(48%) |
6(24%) |
18(72%) |
18(72%) |
||
|
The pharmacist should Provide all necessary information and advice regarding the medication before using it |
Yes |
4(16%) |
21(84%) |
5(20%) |
6(24%) |
<0.00001 |
|
No |
22(88%) |
4(16%) |
20(80%) |
19(76%) |
||
|
It is safe to take common medications and over the counter drugs without the physician or pharmacist’s advice |
Yes |
21(84%) |
3(12%) |
22(88%) |
19(76%) |
<0.000056 |
|
No |
4(16%) |
22(88%) |
3(12%) |
6(24%) |
||
Attitude
Self-medication without physician consultation decreased from 88% to 12% post-intervention (p<0.001). Verification of medication safety before use increased from 16% to 80%.
Table 3. Attitude of study participants on medication use during pregnancy
|
QUESTIONS |
RESPONSE |
INTERVENTION GROUP n=25 (%) |
CONTROL GROUP n=25 (%) |
P value |
||
|
|
|
PRE |
POST |
PRE |
POST |
|
|
Take medication without physician’s prescription |
Yes |
22(88%) |
3(12%) |
20 (80%) |
20(80%) |
<0.00001 |
|
No |
3(12%) |
22(88%) |
5 (20%) |
5(20%) |
||
|
Verify the safety of medication before taking them |
Yes |
4(16%) |
20(80%) |
6 (24%) |
10(40%) |
<0.00001 |
|
No |
21(84%) |
5(20%) |
19(76%) |
15(60%) |
||
|
All medications are the same and can be used in pregnant women |
Yes |
18(72%) |
5(20%) |
15(60%) |
13(60%) |
<0.001411 |
|
No |
7(28%) |
20(80%) |
10(40%) |
12(48%) |
||
|
Avoid medications because of the risk to my baby |
Yes |
16(64%) |
5(20%) |
17(68%) |
14(56%) |
<0.000852 |
|
No |
9(36%) |
20(80%) |
8(32%) |
11(44%) |
||
|
There should be no restriction of drugs during pregnancy because the baby needs it. |
Yes |
21(84%) |
23(92%) |
18(72%) |
18(72%) |
<0.00001 |
|
No |
4(16%) |
2(8%) |
7(28%) |
7(28%) |
||
|
It is better to take natural remedies during pregnancy |
Yes |
20(80%) |
3(12%) |
19(76%) |
16(64%) |
<0.00001 |
|
No |
5(20%) |
22(88%) |
6(24%) |
9(36%) |
||
Practice
Routine use of OTC medications without consultation decreased from 84% to 12% (p<0.001). Consulting pharmacists for advice improved from 24% to 80%.
Table 4. Practice of study participants on medication use during pregnancy
|
QUESTION |
RESPONSE |
INTERVENTION GROUP n=25 (%) |
CONTROL GROUP n=25 (%) |
P value |
||
|
|
|
PRE |
POST |
PRE |
POST |
|
|
Took routine medications without asking your doctor or pharmacist |
YES |
19(76%) |
3(12%) |
18(72%) |
18(72%) |
<0.00001 |
|
NO |
6(24%) |
22(88%) |
7(28%) |
7(28%) |
||
|
Took over-the-counter drugs without asking your doctor or pharmacist |
YES |
21(84%) |
3(12%) |
20(80%) |
19(76%) |
<0.00001 |
|
NO |
3(12%) |
22(88%) |
5(20%) |
6(24%) |
||
|
Saw your doctor to obtain a prescription before taking any medication |
YES |
5(20%) |
20(80%) |
6(24%) |
6(24%) |
<0.00001 |
|
NO |
20(80%) |
5(20%) |
19(76%) |
19(76%) |
||
|
Asked about the drug to know if pregnant women could take it |
YES |
10(40%) |
23(92%) |
7(28%) |
9(36%) |
<0.00001 |
|
NO |
15(60%) |
2(8%) |
18(72%) |
16(64%) |
||
|
Checked the leaflet of the drug you take to know if pregnant women could take it |
YES |
6(24%) |
23(92%) |
10(40%) |
10(40%) |
<0.00001 |
|
NO |
19(76%) |
2(8%) |
15(60%) |
15(60%) |
||
|
Asked the pharmacist for advice regarding the safety of the medications you take during pregnancy |
YES |
6(24%) |
20(80%) |
7(28%) |
10(40%) |
<0.000056 |
|
NO |
19(76%) |
5(20%) |
18(72%) |
15(60%) |
||
Pre- and post-intervention comparison of KAP in intervention group
Figure 5. Pre- and post-intervention comparison of KAP in intervention group
DISCUSSION
The findings indicate that structured pharmaceutical care interventions significantly improve KAP regarding medication use in pregnancy. Misconceptions, such as believing all medications are safe during pregnancy or relying on natural remedies without consultation, were effectively corrected.
These results are consistent with earlier studies from Nigeria, Saudi Arabia, and India, where poor baseline knowledge and misconceptions were common, but education significantly improved awareness and practices.?
The study highlights the crucial role of pharmacists as part of antenatal care teams. Integrating pharmacist-led education during antenatal visits can help reduce unsafe practices, improve adherence, and ultimately prevent adverse outcomes.
Limitations include the small sample size, single-center design, and short follow-up. Larger multicenter studies are recommended to generalize findings.
CONCLUSION
Pharmaceutical care intervention significantly improved knowledge, attitudes, and practices regarding medication use during pregnancy. Incorporating pharmacist counseling into routine antenatal care can enhance maternal safety and promote rational medication use.
ACKNOWLEDGEMENTS
The authors thank Srinivas Institute of Medical Sciences and Research Centre, Mangaluru, and the participants for their cooperation.
REFERENCES
Swathi Gopinath, Blessy Fernandes, A. R. Shabaraya, Knowledge, Attitude and Practice Regarding Medication Use During Pregnancy: Impact of a Pharmaceutical Care Intervention in a Hospital-Based Study, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 9, 1423-1430. https://doi.org/10.5281/zenodo.17113088
10.5281/zenodo.17113088
