Pharmacotherapy of pregnant women at high perinatal risk in real-world clinical practice

Background . In pregnant women at high perinatal risk, irrational pharmacotherapy can lead to ineffective treatment, severe maternal and fetal complications, and increased healthcare costs. Adherence to evidence-based clinical guidelines is therefore critical for optimizing therapeutic outcomes. Objective . To evaluate the pharmacotherapy regimens of pregnant women at high perinatal risk in Saratov and assess their compliance with clinical guidelines. Methods . A retrospective pharmacoepidemiological study was conducted, analyzing 200 outpatient medical records of pregnant women at high perinatal risk. The analysis focused on the structure of prescribed drugs and their daily dosages relative to guideline recommendations. Results . Polypharmacy (concurrent use of ≥5 drugs) was most prevalent in the third trimester (8.5% of patients). The most frequent drug combination was vitamin-mineral complexes with progesterone, prescribed to 11%, 10.5%, and 8.5% of patients in the first, second, and third trimesters, respectively. Widespread non-compliance with guidelines was observed: potassium iodide was dosed inappropriately in 99%, 100%, and 97% of cases across the trimesters; folic acid dosage was incorrect in 70.5% of cases. Antihypertensive therapy was omitted in 57% of patients with arterial hypertension and 77% with gestational hypertension or hypertensive vegetative-vascular dystonia. Drug use was also frequently inconsistent with recommendations for dipyridamole (97% of cases), acetylsalicylic acid (33%), and anticoagulants for thromboembolic prophylaxis (86%). Conclusion . Pharmacotherapy for pregnant women at high perinatal risk in this setting demonstrates significant non-adherence to clinical guidelines, potentially compromising treatment efficacy and safety. These findings underscore the need for enhanced monitoring of prescribing practices and interventions to improve physician adherence to established recommendations.