Drug use during pregnancy and adverse pregnancy outcomes: Epidemiological analysis and safety assessment

Drug use during pregnancy is highly prevalent, but evidence on the safety of such use remains limited. Most newly approved drugs lack sufficient safety data for pregnancy, and the use of traditional Chinese medicines/Chinese patent medicines has surged despite unclear mechanisms. Additionally, the high prevalence of polypharmacy during pregnancy is accompanied by unclear associated risks. This review systematically summarizes the advantages and limitations of current methods for investigating drug use. It provides a comprehensive overview of the epidemiological characteristics, regional variations, and polypharmacy patterns in the use of progestogens, antibiotics, antipyretics and analgesics, psychotropic drugs, and traditional Chinese medicines /Chinese patent medicines during pregnancy. Moreover, it discusses the effects of single-drug and polypharmacy exposure on adverse birth outcomes, elucidates the potential mechanisms underlying the effect of polypharmacy on pregnancy outcomes, and explores the conflicts and limitations of international pregnancy drug classification systems. Understanding the effects and mechanisms of single-drug and polypharmacy exposure on birth outcomes is crucial for establishing a localized risk assessment framework for drug use during pregnancy, developing strategies for the prevention and control of polypharmacy exposure, and supporting evidence-based clinical decision-making for precision drug use during pregnancy.