Safety of over-the-counter medication use in pregnancy from the perspective of contemporary nursing and public health. A review of evidence on the most commonly used active substances and its implications for patient education and rational self-medication

Abstract

ISSN 2084 4212 ISSN 2450 839X Background. Pharmacotherapy in pregnancy always calls for particular caution, yet many of the complaints typical of this period prompt women to reach for over-the-counter (OTC) preparations. The wide availability of these products fosters the erroneous belief that they are entirely safe, especially when they were already used before conception. In reality, the safety profile of individual substances varies and depends on the active substance, the trimester, the dose administered and the duration of exposure. Self-medication is a population-level phenomenon and an important area of health protection, in which nurses, midwives and pharmacists fulfil a key educational and preventive function. Objectives. The aim of this paper is to systematise current knowledge on the safety of the most commonly used OTC medicines in pregnancy, namely analgesic, antipyretic, antiallergic and anticold preparations as well as agents used for gastrointestinal complaints, and to translate this knowledge into the practice of contemporary nursing and midwifery, with particular emphasis on patient education, the development of health literacy and rational self-medication as a component of maternal and child health protection. Material and methods. The analysis was based on data retrieved from PubMed and on current position statements of scientific societies, including ACOG, the FDA and the Polish Society of Gynaecologists and Obstetricians (PTGiP), as well as on Polish Summaries of Product Characteristics available in the national Register of Medicinal Products. Results. Paracetamol remains the safest agent for pain and fever, provided it is used at the lowest effective dose for the shortest possible time. Non-steroidal anti-inflammatory drugs (NSAIDs) require considerable caution, particularly after 20 weeks of gestation, because of the risk of oligohydramnios and premature closure of the ductus arteriosus. Acetylsalicylic acid requires a dose-dependent distinction: analgesic and anti-inflammatory doses should not be used in self-medication during pregnancy, especially after 20 weeks, whereas low antiplatelet doses are recommended in pregnant women at increased risk of preeclampsia. H1 antihistamines have a more favourable safety profile than preparations containing pseudoephedrine. In mild to moderate nausea and vomiting of pregnancy, the combination of vitamin B6 with doxylamine is recommended. Agents for gastrointestinal complaints should be se- lected within a stepwise model. The key principle of rational OTC phar macotherapy is the appraisal of clinical benefit to the woman against potential fetal risk, conducted within interprofessional care and supported by competent counselling from nurses and midwives. Conclusions. OTC status is not equivalent to safety in pregnancy. Given the prevalence of self-medication and the accessibility of non-prescription medicines, it is essential to disseminate knowledge about their safe use and to provide systematic, evidence-based counselling by nurses, midwives and pharmacists, directed towards the protection of maternal and child health.