Uso de medicamentos em gestantes atendidas no sistema único de saúde de Braço do Norte (SC)
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Arquivos
Data
2013
Tipo de documento
Dissertação
Título da Revista
ISSN da Revista
Título de Volume
Área do conhecimento
Ciências da Saúde
Modalidade de acesso
Acesso aberto
Editora
Autores
Maia, Tânia Lunardi
Orientador
Galato, Dayani
Coorientador
Resumo
Objetivo: Identificar o perfil de uso de medicamentos em gestantes acompanhadas nas Unidades Básicas de Saúde do Município de Braço do Norte (SC). Métodos: Trata-se de uma coorte prospectiva, realizada por meio de análise dos prontuários e de registros na caderneta de saúde da criança e de entrevistas com as gestantes durante as consultas de pré-natal e após o parto. Os dados foram coletados entre os meses de março de 2012 e junho de 2013, tendo como critérios de inclusão realizar o pré-natal no Sistema Único de Saúde e estar no máximo na 14a semana de gestação na primeira entrevista. Os desfechos avaliados foram as intercorrências fetais e materno-fetais. Resultados: Foram incluídas no estudo 105 gestantes. Das gestantes, 53,3% estava em uso de medicamentos no momento do diagnóstico da gravidez, 97,1% usou no primeiro trimestre após o diagnóstico, 80,9% e 68,6% foram expostas no segundo e terceiro semestre, respectivamente. O maior percentual de automedicação deu-se antes do diagnóstico (70,7%). Quanto ao uso de medicamentos inseguros, observou-se maior exposição também no primeiro trimestre, tanto pela classificação do Food and Drug Administration (29,1%), quanto pelo órgão sanitário brasileiro Anvisa (42,7%). Das mulheres, 35,2% não adotaram o protocolo do Ministério da Saúde em relação ao uso do ácido fólico e sulfato ferroso. Desta forma, 75,2% das gestantes tiveram exposição inadequada aos medicamentos, seja pelo uso ou pelo não uso desta tecnologia. Houve diferença entre as proporções de medicamentos utilizados segundo a Anatomical Therapeutic Chemical dependendo do período gestacional, no entanto, os principais grupos anatômicos foram de medicamentos que atuam no sangue e órgãos hematopoiéticos, anti-infecciosos de uso sistêmico, trato alimentar e metabólico e sistema nervoso. No diagnóstico da gravidez, observou-se expressivo uso de medicamentos que atuam no sistema geniturinário e os hormônios sexuais (15,2%), em especial os anticoncepcionais orais, o que provavelmente está relacionado com o percentual de gestações não planejadas (63,8%). Entre as intercorrências maternas as mais comuns foram as internações hospitalares (18,1%) e entre as fetais, os abortos (7,6%) e a prematuridade (7,6%). Das mulheres, 40,9% apresentaram alguma intercorrência durante a gestação, enquanto que, 24,8% gestações expuseram os fetos a pelo menos uma intercorrência. Não houve associação entre o uso inadequado de medicamentos com as variáveis maternas e da gestação. Em relação aos desfechos materno-fetais houve associação direta com gestação de alto risco (RR: 2,18 IC95%: 1,46-3,26) e possuir menos de cinco anos de estudo (RR: 1,82 IC95%: 1,16-2,85) e associação inversa com ganho adequado de peso materno (RR: 0,52 IC95%: 0,33-0,81). Os desfechos fetais estiveram associados ao ganho adequado de peso materno (RR: 0,33 IC95%: 0,17-0,63), o qual se mostrou fator de proteção. Conclusão: Os resultados demonstram o expressivo uso de medicamentos durante a gravidez. Mesmo que haja menor exposição aos medicamentos no momento do diagnóstico, observou-se maior consumo de medicamentos de risco e da prática de automedicação neste período da gravidez. Ainda que não tenha sido observada associação entre o uso inadequado de medicamentos e os desfechos fetais e materno-fetais, estes produtos devem ser utilizados de forma racional.
Objective: This study was intended to identify the medication-taking behavior among pregnant women attending the basic healthcare units of the National Public Health System (SUS) in Braço do Norte, state of Santa Catarina, Brazil. Methods: This was a prospective cohort study, conducted through analysis of medical records, personal child health records, and interviews with pregnant women during prenatal and postpartum visits. Data were collected between March 2012 and June 2013. To perform prenatal care at the National Public Health System and being up to week 14 of pregnancy in the first interview were the inclusion criteria for the study. Outcome assessment included fetal anomalies and maternal complications. Results: The study included 105 pregnant women, of whom 53.3% were on medication at the time of pregnancy diagnosis; 97.1% took medications during the first trimester of pregnancy; 80.9% and 68.6% took medications during the second and third trimesters of pregnancy, respectively. The highest percentage of self-medication occurred before pregnancy diagnosis (70.7%). A significantly higher use of unsafe medications was observed during the first trimester of pregnancy, according to the classification by both the Food and Drug Administration (29.1%) and by the Brazilian health surveillance agency Anvisa (42.7%). About a third (35.2%) of pregnant women did not follow the protocol of the Brazilian Ministry of Health regarding the use of folic acid and ferrous sulphate. The findings revealed that 75.2% of the sample subjects took inadequate medications during pregnancy. Difference proportions were observed with regard to the use of medications according to the Anatomical Therapeutic Chemical, depending on the gestational period; however, the main anatomic groups were blood and hematopoietic organs, anti-infective medications for systemic use, and drugs that act in the alimentary tract and central nervous system. At the diagnosis of pregnancy, a significant intake of medications that act on the genitourinary system and sex hormones (15.2%), especially oral contraceptives, was observed, which is probably associated with the unintended pregnancy rate (63.8 %). The most common maternal or fetal outcomes included hospitalization (18.1%), abortion (7.6%) and preterm labor (7.6%). Of the sample subjects, 40.9% had complications during pregnancy, while 24.8% had at least one fetal complication. There was no association between the inappropriate use of medications and maternal and pregnancy variables. Maternal and fetal outcomes were directly associated with high-risk pregnancy (RR: 2.18; 95% CI: 1.46 to 3.26) and having less than five years of education (RR: 1.82; 95% CI: 1.16 to 2, 85), and was inversely associated with adequate maternal weight gain (RR: .52; 95% CI: .33 to .81). The fetal outcomes were associated with adequate maternal weight gain (RR: .33; 95% CI: .17 to .63), which was found to be a protective factor. Conclusion: The results showed significantly high rates of medication use during pregnancy. Even though the use of medications was not elevated at the time of pregnancy diagnosis, high-risk drugs and self-medication were observed during this period of pregnancy. Although no association was observed between the inappropriate use of medications and maternal and fetal outcomes, these products should be used rationally.
Objective: This study was intended to identify the medication-taking behavior among pregnant women attending the basic healthcare units of the National Public Health System (SUS) in Braço do Norte, state of Santa Catarina, Brazil. Methods: This was a prospective cohort study, conducted through analysis of medical records, personal child health records, and interviews with pregnant women during prenatal and postpartum visits. Data were collected between March 2012 and June 2013. To perform prenatal care at the National Public Health System and being up to week 14 of pregnancy in the first interview were the inclusion criteria for the study. Outcome assessment included fetal anomalies and maternal complications. Results: The study included 105 pregnant women, of whom 53.3% were on medication at the time of pregnancy diagnosis; 97.1% took medications during the first trimester of pregnancy; 80.9% and 68.6% took medications during the second and third trimesters of pregnancy, respectively. The highest percentage of self-medication occurred before pregnancy diagnosis (70.7%). A significantly higher use of unsafe medications was observed during the first trimester of pregnancy, according to the classification by both the Food and Drug Administration (29.1%) and by the Brazilian health surveillance agency Anvisa (42.7%). About a third (35.2%) of pregnant women did not follow the protocol of the Brazilian Ministry of Health regarding the use of folic acid and ferrous sulphate. The findings revealed that 75.2% of the sample subjects took inadequate medications during pregnancy. Difference proportions were observed with regard to the use of medications according to the Anatomical Therapeutic Chemical, depending on the gestational period; however, the main anatomic groups were blood and hematopoietic organs, anti-infective medications for systemic use, and drugs that act in the alimentary tract and central nervous system. At the diagnosis of pregnancy, a significant intake of medications that act on the genitourinary system and sex hormones (15.2%), especially oral contraceptives, was observed, which is probably associated with the unintended pregnancy rate (63.8 %). The most common maternal or fetal outcomes included hospitalization (18.1%), abortion (7.6%) and preterm labor (7.6%). Of the sample subjects, 40.9% had complications during pregnancy, while 24.8% had at least one fetal complication. There was no association between the inappropriate use of medications and maternal and pregnancy variables. Maternal and fetal outcomes were directly associated with high-risk pregnancy (RR: 2.18; 95% CI: 1.46 to 3.26) and having less than five years of education (RR: 1.82; 95% CI: 1.16 to 2, 85), and was inversely associated with adequate maternal weight gain (RR: .52; 95% CI: .33 to .81). The fetal outcomes were associated with adequate maternal weight gain (RR: .33; 95% CI: .17 to .63), which was found to be a protective factor. Conclusion: The results showed significantly high rates of medication use during pregnancy. Even though the use of medications was not elevated at the time of pregnancy diagnosis, high-risk drugs and self-medication were observed during this period of pregnancy. Although no association was observed between the inappropriate use of medications and maternal and fetal outcomes, these products should be used rationally.
Palavras-chave
Gravidez - Cuidados médicos, Medicamentos, Pacientes - Cuidados