Determinants of medication adherence to Levothyroxine in pregnant women with Hypothyroidism

Abstract

Objectives: Pregnant women with hypothyroidism require hormone replacement therapy with thyroxine. It is prudent to initiate prompt treatment of hypothyroidism to prevent adverse outcomes in both mother and the neonate. Non-adherence to medication is synonymous with treatment failure, it increases health care costs and may lead to poor quality of life. The aim of this study was to determine the factors contributing to non-adherence to levothyroxine in pregnant women.

Methods: This was a cross-sectional interventional study. Pregnant women >18 years of age, with hypothyroidism on levothyroxine for minimum 3 months were eligible for inclusion. Women with sub-clinical hypothyroidism and those on drugs likely to interfere with thyroxine were excluded.

Results: The study enrolled 75 patients with a mean age of 27.2±4.3 years. The mean duration of illness (hypothyroidism) was 26±30.6 (range, 2-120 months). The mean TSH levels were 3±1.4 (range, 1.1-5.7 milli-international/L). The mean dose of levothyroxine was 64.5±34.8 (range, 12.5-125 mcg). Fifty-three (70.7%) women were taking folic acid supplements and fifteen (20%) women were on alternative and complimentary medications. Morisky, Green and Levine (MGL) medication adherence scale was administered to eligible participants. The study revealed that 54.7% pregnant women with hypothyroidism have low to medium adherence to levothyroxine therapy. Multiple regression analysis revealed that patient’s age, education level and disease insight, gestational age, folic acid supplementation and cost of medication significantly (P<0.05) influenced adherence to levothyroxine in this cohort.

Conclusion; Patient’s age, educational status and disease insight, andmedication costs significantly influence adherence to medication in pregnancy women with hypothyroidism.