|Year : 2019 | Volume
| Issue : 4 | Page : 169-175
Prevalence of self-medication among pregnant Women: A systematic review and meta-analysis
Azam Rahmani1, Suren Akram Hamanajm2, Arezoo Fallahi3, Reza Ghanei Gheshlagh4, Sahar Dalvand5
1 Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Sociology, College of Law, Lebanese French University, Erbil, Kurdistan, Iraq
3 Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
4 Social Determinants of Health Research Center, Research Institute for Health Development; Clinical Care Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
5 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
|Date of Web Publication||14-Oct-2019|
Department of Public Health, Faculty of Health, Kurdistan University of Medical Sciences, Sanandaj, Kurdistan
Source of Support: None, Conflict of Interest: None
Background: Self-medication is prevalent among pregnant women. It can cause adverse effects such as fetal anomalies. Objectives: This study aimed to estimate the prevalence of self-medication among Iranian pregnant women. Methods: This was a systematic review and meta-analysis study. Online national and international databases (namely, Scientific Information Database, MagIran, Web of Science, PubMed, Scopus, and Google Scholar) were searched using the following keywords: “pregnancy,” “gravidity,” “self-treatment,” “self-medication,” “non-prescription,” “over-the-counter,” “self-administered,” “self-reported,” “Iran,” “prevalence,” “occurrence,” “frequency,” and “epidemiology.” In total, 128 studies were retrieved. Only 13 studies fulfilled eligibility criteria, i.e. cross-sectional design and publication in Persian or English. Methodological quality of the studies was assessed using a tool with four items, namely design, sample description, sample size, and methods. Meta-analysis was performed using the random-effects model and heterogeneity among the studies was assessed using the I2 index. Results: The total number of samples in the 13 analyzed studies was 4874. The overall self-medication prevalence was 38.46% (95% confidence interval: 27.42–49.49). Meta-regression analysis revealed no significant relationships between self-medication prevalence and methodological quality score (P = 0.409), participants' mean age (P = 0.400), sample size (P = 0.248), and publication year (P = 0.704). Conclusion: The overall prevalence of self-medication among Iranian pregnant women is 38.46%. Study findings can be used to design and implement interventions to reduce self-medication among pregnant women. Educational interventions are needed to improve the knowledge of pregnant women and health-care providers about the effects of self-medication, particularly herbal self-medication.
Keywords: Iran, Meta-analysis, Nonprescription drugs, Pregnancy, Prevalence, Self-medication
|How to cite this article:|
Rahmani A, Hamanajm SA, Fallahi A, Gheshlagh RG, Dalvand S. Prevalence of self-medication among pregnant Women: A systematic review and meta-analysis. Nurs Midwifery Stud 2019;8:169-75
|How to cite this URL:|
Rahmani A, Hamanajm SA, Fallahi A, Gheshlagh RG, Dalvand S. Prevalence of self-medication among pregnant Women: A systematic review and meta-analysis. Nurs Midwifery Stud [serial online] 2019 [cited 2019 Nov 14];8:169-75. Available from: http://www.nmsjournal.com/text.asp?2019/8/4/169/269097
| Introduction|| |
Self-medication refers to the intake of medications without medical prescription. It is a social, economic, and health challenge. It may occur due to the inadequacy of health-care services, poverty, limited knowledge about the underlying condition, medication advertisements, easy access to medications, sociocultural and economic conditions, and inefficient transportation system. Self-medication can cause different complications such as drug resistance, drug interactions, misdiagnosis, delayed medical help seeking, polypharmacy, drug overuse, side effects and intoxication, treatment inefficiency and prolongation, delayed recovery, and waste of money.
Several studies reported that women resort to self-medication to manage their menstrual disorders, menopausal symptoms, mood imbalance, osteoporosis, and problems related to pregnancy and breastfeeding., A study reported that more than 90% of pregnant women experienced self-medication. The prevalence of self-medication among pregnant women in Tanzania, Ethiopia, northern Europe, and the United Arab Emirates was 46.24%, 20.1%, 62.9%, and 40%, respectively. Self-medication in Iran is also very prevalent ,, so that Iran is among the top twenty countries regarding self-medication. Studies showed that self-medication prevalence among Iranian pregnant women was 54.4% in the center of Iran  and 30% in the West of Iran.
Self-medication in pregnancy can increase the risk of fetal anomalies  and endanger maternal and fetal health. Therefore, assessing and reducing self-medication is essential. There is no conclusive evidence regarding the self-medication prevalence among pregnant women in Iran. The present study was conducted to answer the following question, “What is the prevalence of self-medication among Iranian pregnant women?”
This study was conducted to estimate the prevalence of self-medication among Iranian pregnant women.
| Methods|| |
This systematic review and meta-analysis was conducted on papers published in Iranian and international journals.
Search keywords were “pregnancy,” “gravidity,” “self-treatment,” “self-medication,” “nonprescription,” “over-the-counter,” “self-administered,” “self-reported,” “Iran,” “prevalence,” “occurrence,” “frequency,” and “epidemiology.” These keywords and their combinations were searched in national and international databases, namely Scientific Information Database, MagIran, Web of Science, PubMed, Scopus, and Google Scholar. Where possible, the Boolean operators, namely “AND,” “OR,” were used to narrow or broaden search results [Box 1].
All studies into the prevalence of self-medication among Iranian pregnant women which had been published before June 2018 were retrieved and assessed for eligibility. Eligibility criteria were cross-sectional design and publication in Persian or English. Review studies, studies into the causes and the risk factors of self-medication, and studies with correlational, interventional, cohort, or case–control designs were not included. The reference lists of the retrieved studies were also searched to find other relevant studies. The search process was independently performed by two researchers in order to reduce data collection biases.
A data collection sheet was used to extract data from the retrieved studies about topic, authors' name, publication year, study setting, sample size, mean maternal age, and self-medication prevalence. Studies were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline.
Study appraisal and synthesis
Methodological quality assessment of the studies was performed using the tool introduced by Hoodin and Weber. This tool consists of four items on design, sample description, sample size, and methods. Items are scored 0–3, resulting in a possible total score of 0–12 with higher scores showing greater methodological quality. In the present study, the score of this tool was used to categorize the retrieved studies as low quality (scores <5), moderate quality (scores 5–10), and high quality (scores >10).,
As the prevalence of a phenomenon has a binominal distribution, the variance of self-medication prevalence was calculated using the binominal distribution variance, and a weight was allocated to each study using the inverse variance method. The Cochrane's Q test and the I2 index were used for heterogeneity assessment. Heterogeneity was categorized as low (below 25%), moderate (25%–75%), and high (above 75%). The result of heterogeneity assessment was statistically significant (I2 = 98.7%, Q = 954, and P < 0.001); hence, the DerSimonian and Laird random-effects model was used. Meta-regression analysis was done to assess the relationships of self-medication with publication year, sample size, maternal age, and methodological quality score. Subgroup analysis was also done to estimate the prevalence of self-medication in different geographical regions of Iran and also based on medication type. The Egger's regression method for funnel plot asymmetry was used to evaluate publication bias. Sensitivity analysis was done through excluding studies one by one and assessing the effects of these exclusions on the pooled prevalence. All data analyses were performed via the STATA software (v. 12.0: StataCorp. 2011. Stata Statistical Software: Release 12. College Station, TX, USA: StataCorp LP).
| Results|| |
Initially, 128 studies were retrieved, from which 98 were irrelevant, 7 were duplicates, and 10 did not fulfill eligibility criteria. These 115 studies were excluded and the remaining 13 studies were analyzed [Figure 1].
|Figure 1: The process of screening and selecting relevant studies based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline|
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Sensitivity analysis showed that the one-by-one exclusion of the studies from the analysis did not considerably affect the pooled prevalence of self-medication. Publication bias assessment through the Egger's regression method also showed the absence of publication bias in the studies (P = 0.166).
The overall and the mean sample sizes of the included studies were 4874 and 375, respectively. The smallest and largest sample sizes were related to the studies conducted by Ghanei Gheshlagh et al. and Afshary et al., respectively (116 vs. 801). All studies had moderate methodological quality. [Table 1] presents the characteristics of the studies.
The results of meta-analysis showed that the prevalence of self-medication among Iranian pregnant women was 38.46% (95% confidence interval [CI]: 27.42–49.49, I2 = 98.7%, P = 0.001 and [Figure 2]). The lowest and highest self-medication prevalence rates were reported in studies conducted by Ziaei et al. and Bagheri and Abbaszadeh, respectively (2.20% vs. 54.4%).
|Figure 2: The forest plot of self-medication prevalence among Iranian pregnant women (95% confidence interval for each study is showed in the horizontal line left and right to the mean. The dotted line in the middle shows the total mean of self-medication prevalence. The large diamond on the dotted line represents the 95% confidence interval of the total mean)|
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Meta-regression analysis showed that self-medication prevalence was insignificantly higher in studies with greater maternal age mean (P = 0.40). Self-medication also had no significant relationships with the methodological quality score (P = 0.409), sample size (P = 0.248), and publication year (P = 0.704) of the studies [Figure 3].
|Figure 3: The meta-regression analysis of self-medication based on maternal age (a), methodological quality score (b), sample size (c), and publication year (d)|
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The results of subgroup analysis [Table 2] showed that self-medication prevalence was significantly higher in Region 4 (45.63%, 95% CI: 17.32–73.94) and Region 2 (44.71, 95% CI: 25.70–63.72). Moreover, self-medication prevalence in the herbal and chemical medication group (48.45%, 95% CI: 11.77–85.11) was greater than the chemical medication group (33.87%, 95% CI: 24.29–43.46).
|Table 2: The prevalence of self-medication based on geographical region and medication type|
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Six studies had reported the common over-the-counter medications used by pregnant women. Gastrointestinal medications, antibiotics, vitamins, and analgesics were among the most commonly used medications [Table 3].
|Table 3: The most common over-the-counter medications used by the participants of the analyzed studies|
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| Discussion|| |
Results showed that the overall self-medication prevalence was 38.46%. Previous studies in other countries reported varying prevalence rates for self-medication. In line with our findings, a study in the United Arab Emirates found that self-medication prevalence was 40% and another study in low- and middle-income countries showed that the overall prevalence of self-medication was 31.5%. Compared with our findings, some studies reported higher self-medication prevalence among pregnant women. For instance, a study in Brazil reported that 50% of pregnant women used 1–4 over-the-counter medications. A study in France also showed that the prevalence of self-medication among pregnant and nonpregnant women was 72% and 48%, respectively. Another study in France showed that 59% of pregnant women had experienced at least one instance of self-medication. On the other hand, some studies reported lower self-medication prevalence compared to the rate in our study. For instance, self-medication prevalence was found to be 26.6% in Ethiopia and 21.9% in Mexico.,
The wide difference among self-medication prevalence rates in different areas of the world can be due to the differences in over-the-counter medication patterns and medication prescription systems in different countries. For instance, in some African countries, all medications can be bought without medical prescription. Some reasons for the relatively high prevalence of self-medication in our study are the high costs of frequent medical visits, inadequate health-care insurance coverage, over-the-counter sale of most medications in drugstores, previous history of taking some medications, and inattentiveness to symptoms.
In 1989, a statistical analysis by the World Health Organization in ten countries showed that approximately 60% of pregnant women took at least one over-the-counter medication other than iron-containing products and vitamins. This finding denotes that despite the thalidomide disaster in 1959, self-medication was very high in 1989. A significant factor contributing to the high prevalence of self-medication in pregnancy is pregnant women's wide use of herbal products due to their misconceptions about the insignificant maternal and fetal consequences of these products. Women with unplanned pregnancies are also more at risk for self-medication.
The results of subgroup analysis in our study showed that the prevalence of self-medication varies in different regions of Iran. This finding is attributable to the differences in sociocultural and health-related knowledge, beliefs, attitudes, and behaviors among Iranians in different geographical areas. Moreover, subgroup analysis indicated the higher prevalence of herbal and chemical self-medication compared with chemical self-medication. This higher prevalence of herbal and chemical self-medication compared with chemical self-medication may be due to the belief that herbal products are safe even during pregnancy. However, scientific evidence shows that herbal self-medication during pregnancy can increase the risk of some adverse effects. In Iran, families and friends usually recommend the use of herbal products, while health-care providers generally avoid from such recommendations.,
One potential limitation of the present study was that all analyzed studies had moderate methodological quality. Moreover, incomplete result reporting in the studies prevented more in-depth analysis of the data. Some studies also had dealt with both herbal and chemical products without providing any differential data for these two types of product. Future studies are recommended to use stronger methodological designs (in terms of comparison group and sampling method) to provide more accurate estimate of self-medication prevalence among pregnant women. Moreover, as most previous studies into the prevalence of herbal self-medication in Iran did not address the sources of herbal product prescription, studies are needed to provide detailed data in this area.
The first step to solve a problem is to accurately estimate it in its sociocultural context. The results of this study can be used to plan and implement interventions for reducing self-medication among pregnant women. These interventions may focus on knowledge development among pregnant women and health-care providers regarding self-medication during pregnancy and the potential maternal and fetal adverse effects of herbal self-medication.
| Conclusion|| |
The overall prevalence of self medication among Iranian pregnant women is 38.46% and it varies in different regions of Iran. Study findings can be used to design and implement interventions to reduce self medication among pregnant women. Educational interventions are needed to improve the knowledge of pregnant women and health care providers about the effects of self medication, particularly herbal self medication.
The authors would like to thank all researchers whose works were used in the present study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]