Abstract
Objectives
Use of acetamoniphen (paracetamol or N-acetyl-para-aminophenol [APAP]) during pregnancy is considered safe; however certain practices have been related to the risk of developing neurodevelopmental disorders in offspring. Therefore, the present study aimed to assess women’s knowledge, attitudes and practices (KAP) towards the use APAP during pregnancy and its associated factors.
Methods
This cross-sectional study was conducted between May 15 and August 31, 2020, among pregnant Lebanese women and those who had given birth in the last 12 months. Online self-administered questionnaire was used for data collection. KAP were described and a knowledge score was generated. Multivariable linear models were used to test the association of participants’ sociodemographic characteristics with their knowledge and practices related to the use of APAP.
Results
Out of 305 participants, 72.8% had moderate knowledge about the use of APAP during pregnancy. Actually, more than 50% of them were unable to differentiate between APAP and other pain medications, determine the maximum recommended daily dose, specify the minimum time to wait between doses and identify potential effects of APAP on both mother and unborn child. A higher level of education was associated with a higher knowledge score (β = 2.32, 95%CI=[0.91; 3.73]; p = 0.001). Moreover, women had positive attitudes towards APAP use, perceiving a low risk of toxicity. Indeed, 70.5% of women used APAP at least once during their pregnancy, with 63.7% using it safely. Women with higher knowledge, experiencing at least five somatic symptoms and having a low socioeconomic level tended to be more APAP users (p < 0.05).
Conclusions for Practice
Health professionals have the responsibility to give adequate and personalized advice to women regarding their medicines.
Significance
What is Already Known on this Subject? Acetaminophen (paracetamol or N-acetyl-para-aminophenol [APAP]) is widely regarded as safe and secure during pregnancy. Some recent and conflicting evidence showed a potential association between prenatal use of APAP and an increased odds of neurological adverse effects in childhood. This association might be related to the misuse of APAP and pregnancy trimester.
What does this Study add? The majority of Lebanese women participating in this study consumed APAP safely during pregnancy. Furthermore, they had moderate knowledge about the consumption of APAP during pregnancy and a low risk perception of its toxicity in the unborn child. Thus, health professionals have a responsibility to provide adequate and personalized information to women.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
The data is available upon request.
Code Availability
Not applicable.
References
Abbani, H. (2019). Medical Patriarchy: The Case of Legal Midwives in Lebanon. Kohl: A Journal for Body and Gender Research, 5(2), 132–147. Available at: https://doi.org/10.36583/2019050211.
Amundsen, S., Øvrebø, T., Amble, N., Poole, A., & Nordeng, H. (2016). Use of antimigraine medications and information needs during pregnancy and breastfeeding: A cross-sectional study among 401 Norwegian women. European Journal of Clinical Pharmacology, 72, https://doi.org/10.1007/s00228-016-2127-9.
Amundsen, S., Øvrebø, T. G., Amble, N. M. S., Poole, A. C., & Nordeng, H. (2019). Risk perception, beliefs about medicines and medical adherence among pregnant and breastfeeding women with migraine: Findings from a cross-sectional study in Norway. British Medical Journal Open, 9, e026690. https://doi.org/10.1136/bmjopen-2018-026690.
Atmadani, R. N., Nkoka, O., Yunita, S. L., & Chen, Y. H. (2020). Self-medication and knowledge among pregnant women attending primary healthcare services in Malang, Indonesia: A cross-sectional study. BMC Pregnancy and Childbirth, 20, 42. https://doi.org/10.1186/s12884-020-2736-2.
Beldon, A., & Crozier, S. (2005). Health promotion in pregnancy: The role of the midwife. J R Soc Promot Health, 125, 216–220. https://doi.org/10.1177/146642400512500513.
Bremer, L., Goletzke, J., Wiessner, C., Pagenkemper, M., Gehbauer, C., Becher, H., Tolosa, E., Hecher, K., Arck, P. C., Diemert, A., & Tiegs, G. (2017). Paracetamol medication during pregnancy: Insights on Intake frequencies, dosages and effects on hematopoietic stem cell populations in cord blood from a longitudinal prospective pregnancy cohort. EBioMedicine, 26, 146–151. https://doi.org/10.1016/j.ebiom.2017.10.023.
Central Administration of Statistics (2019). Central Administration of Statistics—Labor Force. http://www.cas.gov.lb/index.php/demographic-and-social-en/laborforce-en.
Chen, M. H., Pan, T. L., Wang, P. W., Hsu, J. W., Huang, K. L., Su, T. P., Li, C. T., Lin, W. C., Tsai, S. J., Chen, T. J., & Bai, Y. M. (2019). Prenatal exposure to Acetaminophen and the risk of Attention-Deficit/Hyperactivity disorder: A nationwide study in Taiwan. Journal of Clinical Psychiatry, 80. https://doi.org/10.4088/JCP.18m12612.
Chew, L. D., Bradley, K. A., & Boyko, E. J. (2004). Brief questions to identify patients with inadequate health literacy. Family Medicine, 36, 588–594.
Coyne, C., Ence, T., Smyres, C., Brennan, J., Castillo, E., & Md, G. (2017). 433 the Relationship between Medication Knowledge, Perceived Importance, and Medication Adherence. Annals of Emergency Medicine, 70, S169. https://doi.org/10.1016/j.annemergmed.2017.07.312.
DeJong, J., Akik, C., El Kak, F., Osman, H., & El-Jardali, F. (2010). The safety and quality of Childbirth in the context of health systems: Mapping maternal health provision in Lebanon. Midwifery, 26, 549–557. https://doi.org/10.1016/j.midw.2010.06.012.
Devkota, R., Khan, G. M., Alam, K., Sapkota, B., & Devkota, D. (2017). Impacts of counseling on knowledge, attitude and practice of medication use during pregnancy. BMC Pregnancy and Childbirth, 17, 131. https://doi.org/10.1186/s12884-017-1316-6.
Harris, G. M. E., Wood, M., Eberhard-Gran, M., Lundqvist, C., & Nordeng, H. (2017). Patterns and predictors of analgesic use in pregnancy: A longitudinal drug utilization study with special focus on women with migraine. Bmc Pregnancy and Childbirth, 17, https://doi.org/10.1186/s12884-017-1399-0.
Ji, Y., Azuine, R. E., Zhang, Y., Hou, W., Hong, X., Wang, G., Riley, A., Pearson, C., Zuckerman, B., & Wang, X. (2020). Association of Cord Plasma Biomarkers of in Utero Acetaminophen exposure with risk of Attention-Deficit/Hyperactivity disorder and autism spectrum disorder in Childhood. JAMA Psychiatry, 77, 180–189. https://doi.org/10.1001/jamapsychiatry.2019.3259.
Khomami, M., Walker, R., Kilpatrick, M., Jersey, S., Skouteris, H., & Moran, L. (2021). The role of midwives and obstetrical nurses in the promotion of healthy lifestyle during pregnancy. Therapeutic Advances in Reproductive Health, 15, 263349412110318. https://doi.org/10.1177/26334941211031866.
Klenø, A. N., Stisen, M. B., Edwards, N. M., Mechlenburg, I., & Pedersen, A. B. (2022). Socioeconomic status and use of analgesic Drugs before and after primary hip arthroplasty: A population-based cohort study of 103,209 patients during 1996–2018. Acta Orthopaedica, 93, 171–178. https://doi.org/10.2340/17453674.2021.955.
Kontogiorgis, C., Nena, E., Berberoglou, E., Moschoni, K., Polyzois, S., Tselemponis, A., & Constantinidis, T. C. (2016). Estimating consumers’ knowledge and attitudes towards Over-the-counter Analgesic Medication in Greece in the years of Financial Crisis: The case of paracetamol. Pain Ther, 5, 19–28. https://doi.org/10.1007/s40122-015-0042-x.
Liew, Z., Ritz, B., Rebordosa, C., Lee, P. C., & Olsen, J. (2014). Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatr, 168, 313–320. https://doi.org/10.1001/jamapediatrics.2013.4914.
Lupattelli, A., Spigset, O., Twigg, M. J., Zagorodnikova, K., Mårdby, A. C., Moretti, M. E., Drozd, M., Panchaud, A., Hämeen-Anttila, K., Rieutord, A., Gjergja Juraski, R., Odalovic, M., Kennedy, D., Rudolf, G., Juch, H., Passier, A., Björnsdóttir, I., & Nordeng, H. (2014). Medication use in pregnancy: A cross-sectional, multinational web-based study. British Medical Journal Open, 4, https://doi.org/10.1136/bmjopen-2013-004365.
Medecins Sans Frontieres (2021). Lebanon | Overlapping crises increase needs and worsen access to care | MSF. In: Médecins Sans Frontières (MSF) International. https://www.msf.org/lebanon-overlapping-crises-increase-needs-and-worsen-access-care. Accessed 14 Mar 2022.
Mickle, A. M., Garvan, C., Service, C., Pop, R., Marks, J., Wu, S., Edberg, J. C., Staud, R., Fillingim, R. B., Bartley, E. J., & Sibille, K. T. (2020). Relationships between Pain, life stress, Sociodemographics, and Cortisol: Contributions of Pain intensity and financial satisfaction. Chronic Stress (Thousand Oaks), 4, 2470547020975758. https://doi.org/10.1177/2470547020975758.
Mitchell, A. A., Gilboa, S. M., Werler, M. M., Kelley, K. E., Louik, C., Hernández-Díaz, S., & National Birth Defects Prevention Study. (2011). Medication use during pregnancy, with particular focus on prescription Drugs: 1976–2008. American Journal of Obstetrics and Gynecology, 205, 51e1–51e8. https://doi.org/10.1016/j.ajog.2011.02.029.
Narayana, G., Pandey, P., Kumar, A. G. A., Kumar, A., Pradeepkumar, B., & Veerabhadrappa, K. V. (2019). Knowledge, attitude and practice of Community pharmacists on Medication Safety during pregnancy: A cross-sectional study. International Journal of Pharmaceutical Investigation, 9, 215–219. https://doi.org/10.5530/ijpi.2019.4.40.
Navaro, M., Vezzosi, L., Santagati, G., Angelillo, I. F., & Collaborative Working Group. (2018). Knowledge, attitudes, and practice regarding medication use in pregnant women in Southern Italy. Plos One, 13, e0198618. https://doi.org/10.1371/journal.pone.0198618.
Panda, A., Pradhan, S., Mohapatro, G., & Kshatri, J. S. (2017). Predictors of over-the-counter medication: A cross-sectional Indian study. Perspectives in Clinical Research, 8, 79–84. https://doi.org/10.4103/2229-3485.203043.
Rachidi, S., Awada, S., Al-Hajje, A., Bawab, W., Zein, S., Saleh, N., & Salameh, P. (2013). DHPS-44525-risky-exposures-during-pregnancy–a-pilot-study-from-lebanes 051413.
Raheel, H., Alsakran, S., Alghamdi, A., Ajarem, M., Alsulami, S., & Mahmood, A. (2017). Antibiotics and over the counter medication use and its correlates among arab pregnant women visiting a tertiary care hospital in Riyadh, Saudi Arabia. Pak J Med Sci, 33, 452–456. https://doi.org/10.12669/pjms.332.12376.
Ramadan, W. H., El Khoury, G. M., Kabbara, W. K., & El Kassis, J. S. (2016). Trends of acetaminophen overuse among ambulatory patients in Lebanon.
Ramia, E., Zeenny, R. M., Hallit, S., Salameh, P., & Order of Pharmacists Scientific Committee – Medication Safety Subcommittee. (2017). Assessment of patients’ knowledge and practices regarding their medication use and risks in Lebanon. Int J Clin Pharm, 39, 1084–1094. https://doi.org/10.1007/s11096-017-0517-4.
Servey, J., & Chang, J. G. (2014). Over-the-counter medications in pregnancy. AFP, 90, 548–555.
Society for Maternal-Fetal Medicine [SMFM]. (2017). Prenatal acetaminophen use and outcomes in children. American Journal of Obstetrics & Gynecology, 216, B14–B15. https://doi.org/10.1016/j.ajog.2017.01.021.
Svendsen, K., Fredheim, O. M., Romundstad, P., Borchgrevink, P. C., & Skurtveit, S. (2014). Persistent opioid use and socio-economic factors: A population-based study in Norway. Acta Anaesthesiologica Scandinavica, 58, 437–445. https://doi.org/10.1111/aas.12281.
Thiele, K., Kessler, T., Arck, P., Erhardt, A., & Tiegs, G. (2013). Acetaminophen and pregnancy: Short- and long-term consequences for mother and child. Journal of Reproductive Immunology, 97, 128–139. https://doi.org/10.1016/j.jri.2012.10.014.
Twigg, M. J., Lupattelli, A., & Nordeng, H. (2016). Women’s beliefs about medication use during their pregnancy: A UK perspective. Int J Clin Pharm, 38, 968–976. https://doi.org/10.1007/s11096-016-0322-5.
Vandenbroucke, J. P., von Elm, E., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., Egger, M., & Initiative for the S. (2007). Strengthening the reporting of Observational studies in Epidemiology (STROBE): Explanation and elaboration. PLOS Medicine, 4, e297. https://doi.org/10.1371/journal.pmed.0040297.
Wakefield, J. R. H., Sani, F., Madhok, V., Norbury, M., & Dugard, P. (2016). The pain of low status: The relationship between subjective socio-economic status and analgesic prescriptions in a Scottish community sample. Psychology, Health and Medicine, 21, 27–37. https://doi.org/10.1080/13548506.2015.1009377.
Zaki, N. M., & Albarraq, A. A. (2014). Use, attitudes and knowledge of medications among pregnant women: A Saudi study. Saudi Pharm J, 22, 419–428. https://doi.org/10.1016/j.jsps.2013.09.001.
Acknowledgements
We would like to thank everyone who contributed to the data collection, especially the Lebanese Order of Midwives as well as Dr. Jamale Alemeh and Dr. Mariam Salloukh.
Funding
No funds were received from any organization to conduct this study.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception, design, and data collection. Berthe Abi Zeid analyzed the data and wrote the first draft of the manuscript. Then, all authors commented on the following versions of the manuscript. Finally, the final manuscript was read and approved by all authors.
Corresponding author
Ethics declarations
Conflict of interest
All the authors don’t have any conflict of interest (financial and non-financial) to disclose.
Ethics Approval
This study was approved by the Research Ethics Committee of the National Institute of Public Health, Clinical Epidemiology & Toxicology (INSPECT-LB) (IRB ID: 2022REC-002-INSPECT-01-19). Therefore, this study has followed the ethical standards, as described in the 1964 Declaration of Helsinki and amendments.
Consent to Participate
The informed consent of the participants to participate in this study was taken. All the data collected were anonymous.
Consent for Publication
Not applicable.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Zeid, B.A., AlHoyeck, M. & Lahoud, N. Consumption of Acetaminophen During Pregnancy: A Survey on Knowledge, Attitudes and Practices of Lebanese Women. Matern Child Health J 28, 532–544 (2024). https://doi.org/10.1007/s10995-023-03817-y
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-023-03817-y