The knowledge, attitude and practice (KAP) of safe medication use among pregnant women in Suzhou, China

Suzhou is characterized by advanced economy, high-quality healthcare, but a low birth rate, making good prenatal and postnatal care a priority, with medication safety as a key component. Medication use during pregnancy is common, yet inappropriate knowledge, attitudes, and practices (KAP) can increase the risk of adverse outcomes for both mother and fetus. Therefore, the study aims to systematically evaluate the KAP of pregnant women regarding safe medication use in Suzhou, China. A hospital-based, multicenter, cross-sectional study in Suzhou from June 2023 to March 2025 was carried out. A validated self‑designed questionnaire was used to assess the knowledge, attitude, and practice among pregnant women. Participants’ demographic, socioeconomic and maternal features were collected as covariates. Univariate and multivariate logistic regression analysis were used to identify the influencing factors for KAP. Restricted cubic splines (RCS) analysis was employed to assess potential nonlinear associations. A total of 2010 valid questionnaires were analyzed. Among the participants, the overall prevalence of medication use was 69.35%, with progestogens (57.11%), iron (12.49%) and levothyroxine (10.60%) being the most commonly used. Regarding safe medication use during pregnancy, 41.29% had good knowledge, 79.10% held good attitudes and 75.32% performed good practices. Higher education (aOR 1.28, 95% CI 1.08–1.50, p = 0.004) and monthly household income (aOR 1.19, 95% CI 1.08–1.31, p < 0.001) were independent positive predictors of knowledge. An inverted U-shaped association was observed between age and knowledge ( p -nonlinear = 0.012), peaking at 32.4 years. For attitude, only education level was significantly associated (aOR 1.42, 95% CI 1.21–1.67, p < 0.001). Significant positive factors influencing practice included older age(aOR 1.05, 95% CI 1.02–1.08, p < 0.001), medical occupation (aOR 1.72, 95% CI 1.04-3.00, p = 0.043), and higher number of medications used (aOR 1.31, 95% CI 1.16–1.47, p < 0.001), while higher education (aOR 0.78, 95% CI 0.65–0.93, p = 0.006) and rural residence(aOR 1.44, 95% CI 1.15–1.80, p < 0.001) was unexpectedly associated with poorer practices. There was inadequate knowledge, yet an overall positive attitude and practice among pregnant women in Suzhou. Higher education level demonstrated significantly better knowledge, more positive attitudes but poorer practices. Tailored interventions should be implemented.