Use of prescription medications potentially harmful during pregnancy among women of reproductive age by pregnancy status and contraceptive use in the United States, 2009-2020

Reprod Health. 2026 Jul 16. doi: 10.1186/s12978-026-02409-7. Online ahead of print.

ABSTRACT

BACKGROUND: Despite recent changes in the labeling of safety risks for prescription medications during pregnancy, information on the use of prescription medications potentially harmful or teratogenic among women of reproductive age is not known. In this study, we examine trends in the use of prescription medications potentially harmful during pregnancy based on pregnancy status and the use of contraceptives in the U.S.

METHODS: We conducted a repeated cross-sectional analysis using five cycles of the National Health and Nutrition Examination Survey (NHANES), 2009-2010 through 2017-2020. Our sample included women aged 20-44 years who reported prescription medication use in the past 30 days. Medications were classified using Micromedex into three fetal risk categories: (1) contraindicated during pregnancy, (2) fetal harm has been demonstrated, and (3) may cause fetal harm. We estimated weighted prevalence of any prescription medication use and use of ≥ 1 potentially harmful medication by pregnancy status (pregnant vs. non-pregnant) and contraceptive use among non-pregnant women. Trends were examined overall, by fetal risk severity, therapeutic class, and specific medications.

RESULTS: Among pregnant women aged 20-44 years, the prevalence of any prescription medication use increased from 28.5% to 37.1% (P<0.05) between 2009 and 2014 and 2015-2020, respectively, while no significant change was observed among non-pregnant women, regardless of contraceptive use. Use of at least one potentially harmful medication remained common among pregnant women (14.6% to 14.5%) and among non-pregnant women, including those not using contraceptives (27.4% to 27.1%). Importantly, the use of two or more potentially harmful medications increased among pregnant women from 1.5% to 5.0% (P<0.05). Antidepressants were the most frequently used potentially harmful medications across women of reproductive age; among pregnant women, antidepressant use increased from 2.6% to 7.1% (P = 0.12), driven largely by sertraline use, which increased from 0% to 5.4%.

CONCLUSIONS: Prescription medications with potential fetal risk are commonly used among women of reproductive age, including pregnant and non-pregnant women who are not using contraceptives, especially antidepressants. These findings highlight the need for continued monitoring of maternal mental health treatment and increased awareness of medication safety during pregnancy.

PMID:42458467 | DOI:10.1186/s12978-026-02409-7