Polypharmacy during pregnancy: a 30-year retrospective analysis of trends and maternal risk factors in Hungary

Abstract Background Polypharmacy during pregnancy poses potential risks related to medication exposure. Limited research has focused on how maternal factors, including age and morbidity type (acute, chronic, and pregnancy-related), influence the overall medication burden during pregnancy. Aims We aimed to estimate the prevalence of polypharmacy over decades, identify key maternal risk factors, and, secondarily, examine trends in medication classes by age group. Methods We retrospectively examined 89,278 pregnancies from the Hungarian Case-Control Surveillance of Congenital Abnormalities dataset (1980–2009). We used multivariate logistic regression models to estimate adjusted odds ratios (aORs) for predictors of polypharmacy. Results Overall, polypharmacy affected 17.2% of women in the first trimester and 39.8% throughout pregnancy, with a significant decline from 23.7% to 50.5% in the 1980s to 6.3% and 19.0% in the 2000s, respectively. Pregnant women aged ≥ 35 years had greater odds of polypharmacy in both periods (first trimester aOR 1.34; entire pregnancy aOR 1.28) compared to women aged ≤ 19 years. Having two or more acute or chronic conditions markedly increased the odds of polypharmacy (aORs > 8.4). A lower polypharmacy risk was associated with parity ≥ 1 and with being unemployed or low-skilled. The use of medication classes varied considerably by maternal age; for example, systemic antibacterials use peaked in women aged 20–24 years, whereas the use of antihypertensives and antidiabetics increased with maternal age. Conclusion Although the rate of polypharmacy during pregnancy declined over the three decades studied, it remained common. Maternal age and morbidity were strongly associated with increased medication burden, with distinct age-related patterns in medication use, highlighting the need for individualized, risk-adjusted prescribing in antenatal care.