Accepted for/Published in: JMIR Formative Research
Date Submitted: Jul 17, 2023
Date Accepted: Oct 20, 2023
Self-reported Medication Utilization Across Racial and Rural/Urban Sub-groups of Pregnant People in the U.S.: A Decentralized App-Based Cohort Study
ABSTRACT
Background:
Maternal health outcomes have been under-researched due to pregnant people being underrepresented or excluded from studies based on their status as a vulnerable population. Medication use, safety, dosing, and efficacy have been particularly understudied in pregnant people, even though it has been shown up to 95% of pregnant people take medications. Utilization of medications and prenatal vitamins across under-represented pregnant populations is not well understood, particulary for communities that are underrepresented in biomedical research (UBR).
Objective:
We aimed to characterize and compare the use of prenatal vitamins, and commonly used over the counter and prescription medications, among pregnant people self-identifying as Black versus non-Black and those living in rural versus urban regions in the United States.
Methods:
We conducted a prospective, decentralized study of 4,130 pregnant study participants who answered survey questionnaires using a mobile research app. All pregnant people living in the U.S. comfortable with reading and writing in English were eligible. The study was conducted in a decentralized fashion with the use of a study app to facilitate enrollment using an eConsent and self-reported data collection.
Results:
Among the study population, there was significantly different utilization of prenatal vitamins, antiemetics, antidepressants, and pain medication across different UBR sub-populations. Black participants reported significantly lower frequencies of prenatal vitamin use compared to non-Black participants (p<0.0001). The frequency of participants who were currently receiving treatment for anxiety and depression also differed by both racial and rural/urban sub-groups. There was significantly lower use of antidepressants (p=0.002) and antiemetics (p=0.02) among Black compared to non-Black participants.
Conclusions:
A prospective decentralized study demonstrated lower use of prenatal vitamins among Black, non-White, and rural pregnant participants and lower use of anti-emetics among Black pregnant participants. Additional research dedicated to identifying how and why these utilization disparities exist can help improve maternal health outcomes, specifically for diverse communities. Clinical Trial: NCT03085875
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