Приверженность лечению беременных с различными видами патологии: клинико психологический обзор зарубежных исследований: ТЕОРЕТИЧЕСКИЕ И АНАЛИТИЧЕСКИЕ ОБЗОРЫ

Мария Александровна  Коргожа; Алеся Олеговна  Евмененко; Софья Михайловна  Музыченко

Treatment adherence in pregnant women with various types of pathology: a clinical psychological review of international studies

THEORETICAL AND ANALYTICAL REVIEWS

Maria A. Korgozha Saint Petersburg State Pediatric Medical University https://orcid.org/0000-0001-8422-1772
Alesya O. Evmenenko Saint Petersburg State Pediatric Medical University https://orcid.org/0000-0003-0048-2196
Sofya M. Muzychenko Saint Petersburg State Pediatric Medical University https://orcid.org/0009-0006-9746-2632

Keywords:

treatment adherence pregnancy HIV infection gestational diabetes mellitus iron deficiency anemia arterial hypertension epilepsy psychopharmacotherapy psychological factors приверженность лечению беременность ВИЧ инфекция гестационный сахарный диабет железодефицитная анемия артериальная гипертензия эпилепсия психофармакотерапия психологические факторы

Abstract

Introduction. During pregnancy, adherence to treatment acquires special clinical and psychological significance, as following medical recommendations affects not only the woman’s health but also the well-being of the fetus. At the same time, adherence among pregnant women varies considerably depending on the type of pathology, nature of the disease, treatment modality, perceived safety of therapy, and quality of communication with healthcare professionals. The aim of this review is to summarize data from international studies on treatment adherence in pregnant women with various somatic, infectious, and psychiatric conditions, and to identify nosology-specific and cross-cutting clinical and psychological barriers to following medical recommendations. Materials and methods. A thematic analysis was performed on materials drawn from a broader review of treatment adherence during pregnancy. The analysis focused on publications addressing antiretroviral therapy for HIV infection, management of diabetes mellitus and gestational diabetes mellitus, prevention and treatment of iron deficiency anemia, antihypertensive therapy and self-monitoring of blood pressure, antiepileptic therapy, as well as psychotherapy and psychopharmacotherapy during pregnancy. Results. The most pronounced barriers to adherence in pregnant women include lack of knowledge about the disease and its treatment, fear of harm to the fetus, side effects of therapy, financial and organizational constraints, stigmatization, depressive and anxiety symptoms, low self-efficacy, insufficient social support, and low trust in the physician. Conversely, motivation focused on the future child’s well-being, clear explanations of treatment benefits and safety, prior treatment experience, and support from close others can enhance adherence. Conclusions. Treatment adherence in pregnant women cannot be viewed as a single universal indicator. Its content and barriers change substantially depending on the clinical context: in HIV infection, the dominant barriers are stigma and access to care; in gestational diabetes — acceptance of the diagnosis and lifestyle change; in anemia — medication availability and treatment tolerability; in hypertensive conditions — regularity of self-monitoring; in epilepsy — the balance between seizure risk and teratogenic concerns; in psychiatric disorders — ambivalence and fear of harm to the child. A promising direction is the development of differentiated medical and psychological programs to improve treatment adherence during pregnancy, taking into account the patient’s health status, the nature of prescribed therapy, and the leading barriers to following medical recommendations.

Author Biographies

Maria A. Korgozha, Saint Petersburg State Pediatric Medical University

Cand. Sci. (Psychol. Science), Associate Professor, Dept. of Clinical Psychology

Alesya O. Evmenenko, Saint Petersburg State Pediatric Medical University

Senior Lecturer, Dept. of Clinical Psychology

Sofya M. Muzychenko, Saint Petersburg State Pediatric Medical University

Postgraduate Student, Dept. of Clinical Psychology

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