Medication adherence in pregnancy- The MAP-A Study
Research type
Research Study
Full title
Medication adherence in pregnancy- the MAP-A Study
IRAS ID
277034
Contact name
Christy Burden
Contact email
Sponsor organisation
North Bristol NHS Trust
Duration of Study in the UK
0 years, 8 months, 1 days
Research summary
Research Summary
Pre-eclampsia is a common pregnancy complication in the UK affecting 5-8% of pregnancies (54000 women). It is a cause of death and complications for the mother and baby. Every year 1,000 babies and 7 mothers die due to pre-eclampsia, and it is associated with risk of fetal growth restriction and prematurity, which are linked to long term health consequences for the baby.
There is no known cure for pre-eclampsia. However, 30 trials have tested low-dose aspirin (80-120mg) and the results support its use, with no evidence of serious side effects. NICE recommends the use of low-dose aspirin in pregnant women who are at high risk of pre-eclampsia. These are women having their first baby, a long gap between pregnancies, high body-mass index, history of pre-eclampsia, diabetes mellitus and other inflammatory or connective tissue disorders. Currently 25% of women in the UK are at risk. It has been identified that up to 50% of pregnant women do not take their aspirin. Improving adherence is therefore important.
Multiple reasons for non-adherence are reported; these are intentional (planning not to take it) and non-intentional (for example, forgetting). A questionnaire study found that 72.8% of women reported deliberately avoiding medication due to concerns about harming the baby. Research looking at other medications indicates that risk perceptions and beliefs are important drivers in decision-making about medication. To be able to intervene to support women to take aspirin it is important to understand their beliefs and risk perceptions relating to it.
This study will use in-depth interviews to investigate pregnant women's risk perceptions and beliefs, and practical barriers to taking aspirin. Pregnant women recommended aspirin will be identified and interviewed in the medical outpatients clinic and the findings will be used to inform development of an intervention for them.Summary of Results
15 women who had been recommended low-dose aspirin (LDA) to prevent a problem with their placenta in pregnancy (placental dysfunction) participated in this study. Of these, 12 reported that they were missing doses or not taking their LDA at all.
We found that women reported limited understanding of why they had been recommended LDA unless they had a personal or family history of a placental problem (e.g. growth restricted baby, previous pre-eclampsia, stillbirth), and many did not understand what the health impact of placental dysfunction might be for them and their baby. They reported that they had limited discussion with the clinician who had recommended it, and that healthcare staff rarely followed-up about taking LDA in later appointments which impacted some women's motivation to take it. There was varied understanding about the dose needed, and when and how it should be taken. Some women were prescribed the LDA whereas others were asked to buy it. In those who were motivated to take it, many experienced difficulties with remembering to take it at night, and some did not know how to deal with a missed dose. Many women wanted more information from their healthcare team about why LDA was recommended.REC name
London - London Bridge Research Ethics Committee
REC reference
20/LO/0169
Date of REC Opinion
11 Feb 2020
REC opinion
Favourable Opinion