A comparative study to monitor drug adherence to antihypertensive drugs among preeclamptic women and to determine factors contributing to drug compliance restrictions.

Introduction

Preeclampsia, one of the most common and dangerous pregnancy disorders, is considered to impact 4–5% of pregnancies globally.¹ Worldwide and in India, 7-8% of maternal deaths are directly associated with pregnancy-related hypertension diseases.²

Preeclampsia is characterized by the de novo development of hypertension, signs of maternal organ dysfunction after the 20th week of pregnancy, and proteinuria of recent onset >300 mg/day. It also includes other signs of renal impairment, hematological and biochemical issues, hepatic dysfunction, neurological abnormalities, and/or signs of uteroplacental dysfunction, like fetal growth restriction.³

The most commonly used antihypertensive drugs in pregnancy are Labetalol, nifedipine, or magnesium sulphate, and they are advised as the first line of treatment for preeclampsia.⁴ Strong adherence to treatment for disorders brought on by pregnancy, such as gestational hypertension, has been highlighted as vital to improving maternal and fetal health outcomes.⁵

Despite evidence to the contrary, it is a concern that pregnant women do not take their antihypertensive drugs as prescribed. In a study conducted by Sontakke S., Takalikar V., et al., it was shown that, in addition to several minor reasons for non-adherence, ignorance about the efficacy of each treatment and amnesia were the main factors.⁶

Monitoring adherence involves determining how closely a patient’s medication use comports with the course of therapy that has been prescribed. As a result, it is considered the most reliable and efficient method for bringing about significant changes in medication adherence. Applications for adherence therapies can be direct, indirect, or both, and data analysis would demonstrate the effects of interventions.⁷ Strict medication compliance is maintained by monitoring drug adherence, which is required to maintain administration time, dosage amount, and frequency. As a result, high medication adherence leads to fewer health risks, increased therapeutic benefits, and potential adverse drug effects in the case of a disease that can be completely treated.^8,9

This study aims to fill the research gap pertaining to non-adherence to drugs in rural areas. Pregnant patients with preeclampsia are the focus of this study, which aims to evaluate their level of compliance and awareness of drug adherence. Drug non-adherence is multifactorial, and assessing the associated barriers can help improve adherence, reduce cost burden, optimize drug therapy, and tailor patient-specific interventions.

Protocol

Discussion

Through this study, we aim to assess the knowledge and skills and spread awareness regarding behavioural regulations in order to improve adherence. By periodic drug adherence monitoring, we ought to find the reasons for non-compliance to antihypertensive drugs in preeclamptic women. The adherence will be carefully reviewed through a well formulated questionnaire and will aid in distinguishing adherent patients from those who are non-adherent. The results obtained from this study can be further applied to tailoring interventions in order to increase drug adherence and reduce associated complications.

Wallis AB, et al. in their study examined 18 years of data until 2004, highlighting notable shifts in preeclampsia, eclampsia, and gestational hypertension rates. Preeclampsia and gestational hypertension rates surged, while eclampsia rates decreased. The findings emphasize the importance of holistic maternal care and ongoing research into preventable causes.¹ Turbeville HR, et al, in their study found that the intricate challenge posed by preeclampsia necessitates comprehensive action globally. Existing gaps in prevention, screening, and treatment highlight the need for a deeper understanding of pathogenesis. Insights into postpartum effects could unveil new therapeutic targets, enhancing maternal and fetal health. Long-term follow-up studies are vital, despite coding variations in records. The shared objective is clear: enhanced preeclampsia management, detection, and care, ultimately benefiting women and children worldwide.³

Odigboegwu O, et al. in their study concluded that hypertension management in preeclampsia varies based on severity and comorbidities. Labetalol, calcium channel blockers are suggested first-line agents, with intravenous labetalol, hydralazine, or nifedipine for acute severe hypertension. Post-preeclampsia, there’s a heightened risk of cardiovascular and renal disease, necessitating improved screening and prevention strategies to mitigate late-disease burdens.⁴ According to the study of Helou A, et al. it was found that in pregnant women receiving anti-hypertensives, prevalent suboptimal adherence was unrelated to hypertension subtype or age but linked to medication understanding, dose memory, and tolerance of medical issues. Collaboration of healthcare professionals like pharmacists, general practitioners, and obstetricians is crucial to enhance adherence and patient outcomes, necessitating further investigation into interventions’ impact on adherence and health results.⁵ Sontakke S, et al. in their study summarised that patient adherence to pregnancy treatment is critical. Encouragingly, adherence to chronic illness medications is higher, yet poor adherence to normal pregnancy meds is concerning. Addressing reported nonadherence issues through interventions involving healthcare professionals can enhance pregnancy outcomes and care.⁶

Ambad, et al. in their study discussed about the effects of multi vitamins supplementation in the prevention of preeclampsia.¹² In a study conducted by Ambad, et al. the role of oxidative stress and antioxidants in preeclampsia was analysed and reviewed.¹³ Bhalerao K, Pajai S in their study protocol discussed about the maternal serum anti-mullerian hormone levels in antenatal women as predictor of preeclampsia.¹⁴ Khandelwal, S., et al. in their study analysed the use of urinary calcium and creatinine ratio in prediction of preeclampsia.¹⁵ Patwa PA, et al. in their study discussed about the utility of uterine artery doppler indices for prediction of preeclampsia.¹⁶

This study aspires to bridge the research gap in non-adherence to antihypertensive drugs among pregnant women with preeclampsia in rural areas. By assessing awareness and compliance barriers, the study aims to facilitate tailored interventions for improving adherence and reducing associated complications.