Risk Awareness about Tetracycline-Induced Tooth Discolouration among Pregnant Women attending the University of Port-Harcourt Teaching Hospital Antenatal Clinic in Nigeria

Risk Awareness about Tetracycline-Induced Tooth Discolouration among Pregnant Women attending the University of Port-Harcourt Teaching Hospital Antenatal Clinic in Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk Awareness about Tetracycline-Induced Tooth Discolouration among Pregnant Women attending the University of Port-Harcourt Teaching Hospital Antenatal Clinic in Nigeria Henry Obiora Chukwudi, Babatope Osagbemiro This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7023176/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background There are no existing data on the risk awareness of pregnant women regarding the use of tetracycline during pregnancy, particularly concerning tetracycline-induced tooth discolouration. The lack of data, coupled with prior research findings that revealed high self-medication habits among pregnant women in Nigeria, prompted this study. This study aimed to determine the risk awareness of pregnant women about tetracycline induced tooth discolouration, its use in pregnancy and self-mediation of tetracycline among pregnant women. Methods The study was a descriptive, cross sectional study that collected data from a convenience sample of pregnant women attending the antenatal clinic of the University of Port-Harcourt Teaching Hospital (UPTH), Nigeria. The data were collected between 3rd June, 2024 and 26th July, 2024. A self-administered questionnaire was used to collect information on sociodemographic characteristics (age, occupation, educational level and number of previous pregnancies), self-medication with tetracycline, and risk awareness of its use in pregnancy and awareness of tetracycline induced tooth discolouration. The data were entered into SPSS (Statistical Package and Software Solutions) Version 26 for Windows, and descriptive analysis and a chi-square test were used to determine the associations between the level of education and self-medication with respect to tetracycline. Results Among the 130 participants, 71.5% had no knowledge that tetracycline use during pregnancy induced tooth discolouration in the child. Additionally, 30 (23.1%) participants were totally unaware that tetracycline use was contraindicated during pregnancy. In addition, 13 (10.0%) participants reported self-medication with tetracycline and 71 (54.6%) reported self-medication during pregnancy. A chi-square analysis revealed a statistically significant association between the level of education and self-medication with tetracycline. Conclusions The poor awareness of tetracycline-induced tooth discolouration among pregnant women attending the antenatal clinic in UPTH raises public health concerns for an increased risk of the unprescribed use of tetracycline. Information sharing about tetracycline-induced discolouration during antenatal clinics may improve awareness, reduce self-medication with tetracycline and address public health concerns of tetracycline-induced tooth discolouration. Tetracycline Tooth discolouration Pregnancy Self-medication Figures Figure 1 Figure 2 Background Tetracycline constitutes a group of broad-spectrum antibiotics with demonstrated efficacy against both gram-positive and gram-negative organisms, exerting bacteriostatic effects on infective agents.[ 1 ] The inherent risk associated with the use of tetracycline during pregnancy, notably the occurrence of tooth discolouration has been established in previous studies. [ 1 ] This adverse effect can occur during pregnancy, particularly around the fourth month of gestation when the calcification process of primary teeth commences. [ 2 ] Thus, careful consideration of the risk-benefit profile before the administration or prescription of tetracycline by healthcare professionals is necessary, given the potential impacts on both maternal and foetal health during the gestation and postnatal periods. [ 3 ] In 1979[ 4 ], the United States Food and Drug Administration (FDA) introduced a classification system to categorize drug safety levels for use in pregnant women or nursing mothers. While this labelling system has undergone modifications [ 5 ], the previous categorization placed drugs into categories A, B, C, D, and X on the basis of established evidence of safety [ 4 ]. Category A denoted drugs with proven safety for use during pregnancy, whereas category X indicated drugs associated with potential teratogenic effects in pregnant women. The safety considerations for drug utilization become particularly critical when addressing the use of antibiotics during pregnancy. Antibiotics, which serve as therapeutic agents against infectious organisms, carry potential risks when used during pregnancy, with tetracycline and its derivatives serving as notable examples. [ 2 ] Tetracycline has an affinity for binding with calcium, resulting in the formation of a complex known as the tetracycline-calcium orthophosphate complex. [ 2 , 6 ] This complex is subsequently deposited at sites of mineralization in teeth and bones during their developmental stages. The discernible impact of tetracycline on foetal development has led to its classification as a category D drug by the U.S. Food and Drug Administration (FDA).[ 4 ] Despite this designation, the use of tetracycline during pregnancy has been documented. [ 7 ] A Hungarian study reported a prevalence rate of 0.7% for the use of tetracycline, including its derivatives, oxytetracycline and doxycycline. [ 8 ] Additionally, a multicentre study conducted in Nigeria revealed a higher prevalence rate of doxycycline usage at 6.2%. [ 7 ] Despite the low prevalence of tetracycline use in various studies, these investigations have often overlooked the potential influence of pregnant women's self-medication practices on their exposure to tetracycline. A qualitative review study conducted in Nigeria highlighted a notable rate of self-medication among pregnant women, with reported prevalence rates of 31%, 66.7% and 72.4%. [ 9 – 11 ] Therefore, there is a compelling rationale for investigating the self-medication behaviours on tetracycline among pregnant women in Nigeria. In prior research conducted beyond Nigeria, a heightened level of risk awareness among pregnant women regarding antibiotic use during pregnancy has been demonstrated.[ 12 – 15 ] However, these studies generally treated antibiotics as a singular entity, neglecting potential variations in awareness levels pertaining to individual antibiotic agents. A recent investigation conducted within Nigeria, focusing on nursing mothers as its study participants, revealed that fewer than half of the respondents possessed an awareness of the risks associated with the use of tetracycline during childhood. [ 16 ] In light of these observations, this study determined the awareness of the risk among pregnant women concerning tetracycline-induced tooth discolouration, awareness of the risk with using tetracycline during pregnancy and the prevalence of tetracycline self-medication among pregnant women. Materials and Method Study design and Study population. This was a cross-sectional descriptive study, carried out among pregnant women visiting the antenatal clinic of the Obstetrics and Gynaecology department in the University of Port-Harcourt Teaching Hospital (UPTH), using a specially designed, self-administered questionnaire. Informed consent was taken from each participants before administering the questionnaire, and this was done anonymously so as to ensure that the participants could provide honest and unbiased responses without concerns for breach of confidentiality. The questionnaire was refined through a pre-test conducted among similar population group, to improve language precision and ensure easy comprehension among all participants demography. Each item in the questionnaire was carefully designed to avoid leading questions or suggestive language so as to reduce the possibility for response bias. Sample size and Sampling technique The sample size was determined using the Cochrane’s formula for determining sample size in a population greater than 10, 000. [ 17 ] $$\:n=\frac{{Z}^{2}p(1-p)}{{d}^{2}}$$ Where; n = desired sample size Z = Standard normal deviate P = Expected prevalence D = Error margin P = 9.2% [ 18 ] D = 5% (0.05) Z = 1.96 (at type 1 error of 5%) $$\:n=\frac{{1.96}^{2}\:\times\:0.092\:\left(1-0.092\right)}{{0.05}^{2}}$$ $$\:n=128.36\:\cong\:128$$ The total number of participants sampled for this study was 130. A convenience sampling was used to select participants for this study. Pregnant women attending the antenatal clinic of the Obstetrics and Gynaecology department in UPTH during the study period were selected consecutively until the sample of 130 was reached. Data Collection The questionnaire was distributed among pregnant women seen on each visit day to the clinic from Monday to Friday, from the period of 1st of June, 2024 to 27th of July, 2024. A verbal and written consent was obtained before the questionnaire was filled by the participants. The questionnaire given was divided into four sections. Section A was designed to extract the socio-demographic variables such as age, occupation, level of education, marital status, gestational age and number of previous pregnancy. Section B consists of questions aimed at obtaining information on the Tetracycline self-medication habits of pregnant women. Each question required the respondents to tick either a Yes or a No wherever applicable. Section C was designed to extract information on the awareness of pregnant women as regards the risks of using tetracycline in pregnancy. The response gotten was recorded on a 4-point awareness Likert scale, ranging from totally unaware to very aware. Section D was designed to extract information on the awareness of pregnant women about tetracycline induced tooth discolouration in their child if used during pregnancy. To assess the level of knowledge about tetracycline induced tooth discolouration among the participants, five variables were tested, each on a three point Likert scale of false, I don’t know and true (questions answered with I don’t know and false were given a score of zero and one respectively and those answered as true, a score of two). Thus the highest obtainable score was ten, and consequently those who scored between six and ten were considered as having a good knowledge, those scoring between one and five were considered as having poor knowledge and a score of zero considered as having no knowledge on tetracycline induced tooth discolouration. Data Analysis The data collected was analysed using IBM Statistical Product and Service Solution (SPSS) version 27 software for windows. Prior to analysis, a Cronbach’s alpha reliability test was used to test the internal consistencies of the responses in the Likert scale, having a score of 0.98, indicating good internal consistency. Categorical variables (Age, Occupation, level of education) was expressed in frequency and percentages. Numerical variables was presented using means and standard deviation. The results was presented in the form of tables and figures. Chi-square test of significance was used to show the association between the level of education, and self-medication on tetracycline among the pregnant women. Variables that failed the chi-square assumption test, Fisher’s exact test was used to test the significance. All statistical significances were assumed at p values < 0.05. Results Socio-demographic characteristics of the study participants. A total of 130 pregnant women were recruited for this study and complete responses were obtained from all the participants. Table 1 , shows the socio-demographic characteristics of the study participants. Age distribution among the study participants, showed most of the participants (n = 41, 31.5%) were between the age of 26 to 30 years and the lowest age group (n = 6, 4.60%) being between 41 and 45 years. In terms of occupation, most of the participants were skilled workers (n = 62, 47.7%), followed by the semi-skilled workers (n = 22, 16.9%) and the lowest being the unskilled workers population (n = 11, 8.5%). More than half of the study population (n = 78, 60%) have completed tertiary education and only (n = 12, 9.2%) have no formal education. The Marital status showed that most were married (n = 99, 76.2%), with only (n = 16 12.3%) being single and (n = 15, 11.5%) divorced. The gestational age distribution of participants is such that most of the participants (n = 75, 57.7%) were in their second trimester, (n = 30, 23.1%) in their first trimester while (n = 25, 19.2%) in the third trimester of pregnancy. Among the participants, (n = 73, 56.2%) have had two or more pregnancies previously while (n = 57, 43.8%) have had one previous pregnancy. Table 1 ; Social-demographic distribution of the participants Characteristics Frequency (N = 130) Percentage (%) Age group (Years) 21–25 27 20.70 26–30 41 31.50 31–35 35 27.00 36–40 21 16.20 41–45 6 4.60 Occupation Professional 16 12.30 Skilled worker 62 47.70 Semi-skilled worker 22 16.90 Unskilled worker 11 8.50 Dependent 19 14.60 Level of education No formal education 12 9.20 Primary education 15 11.50 Secondary education 25 19.20 Tertiary education 78 60.00 Marital status Single 16 12.30 Married 99 76.20 Divorced 15 11.50 Gestational age First Trimester 30 23.10 Second Trimester 75 57.70 Third Trimester 25 19.20 Number of previous pregnancies One 57 43.80 Two or more 73 56.20 Self-medication habit on tetracycline. Table 2 shows that less than half of the respondents (n = 13, 10%) indicated self-medicating on tetracycline during pregnancy, with most doing this during their first trimester (n = 12, 9.2%) of pregnancy. They mostly stated that the reason for doing this was because it was previously suggested by a family members (n = 9, 6.9%). The common source of this drug were from roadside pharmacy shops (n = 10, 7.7%) and dosage gotten from a pharmacist or family and friends (n = 6, 4.6%). Table 2 ; Self-medicating habits among pregnant women Frequency (N) Percentage (%) History of self-medication Yes 71 54.60 No 59 45.40 Reason for self-medication It was previously given to me by a doctor 18 13.80 It was previously given to me by a pharmacist 23 17.70 I always have the drugs at home 14 10.80 It was previously suggested by family members 11 8.50 It was previously suggested by friends 5 3.80 Have you taken tetracycline during pregnancy, without the doctor telling you to? Yes 13 10.00 No 117 90.00 If yes to the question above, at what time of pregnancy? First Trimester 12 9.20 Second Trimester 1 0.80 If yes to the question above, reasons for taking tetracycline without the doctor telling you to? It was previously given to me by a pharmacist 3 2.30 It was previously suggested by family members 9 6.90 It was previously suggested by friends 1 0.80 Where do you get the tetracycline drug? Roadside pharmacy shops 10 7.70 Local chemist shops 3 2.30 How did you know the dosage of tetracycline to use? I asked a pharmacist 6 4.60 I asked my family and friends 6 4.60 From my last use 1 0.80 Table 3 shows the association between pregnant women who self-medicate during pregnancy and self-medicate on tetracycline during pregnancy. Among the women that self-medicate during pregnancy, n = 13, 18.3% of the participants indicated self-medicating on tetracycline during pregnancy. Table 3 Association between the self-medicating habit of pregnant women and tetracycline use among pregnant women Do you take drugs without the doctor telling you to? Total Yes No Have you taken tetracycline during pregnancy, without the doctor telling you to? Yes 13 (18.3%) 0 13 No 58 (83.1%) 59 117 Total 71 59 130 A chi square analysis was done to test the association between the level of education of the respondents and use of tetracycline among pregnant women. The result showed that 41.7% (n = 5) of those with no formal education self-medicate with tetracycline during pregnancy compared to 2.6% (n = 2) of those with tertiary education this was statistically significant with p = 0.001 (Table 4 ) Table 4 Association between level of education and use of tetracycline among pregnant women Have you taken tetracycline during pregnancy, without the doctor telling you to? Yes (%) No (%) Total Level of education No formal education 5 (41.7%) 7 (58.3%) 12 Primary education 2 (13.3%) 13 (86.7%) 15 Secondary education 4 (16.0%) 21 (84.0%) 25 Tertiary education 2 (2.6%) 76 (97.4%) 78 Total 13 (10%) 117 (90%) 130 p- value = 0.001 Phi effect size = 0.386 Knowledge about Tetracycline-Induced Tooth Discolouration Figure 1 , depicts the level of knowledge of pregnant women, regarding the risk of tetracycline-induced tooth discolouration occurring in their child if used during pregnancy, with 71.5% having no knowledge, 21.4% having a good knowledge and 7.1% having a poor knowledge about tetracycline-induced tooth discolouration. Risk Awareness about Tetracycline-Induced Tooth Discolouration With regards to the risk awareness of its unsafety for use in pregnancy, 59% of the respondents admitted to being very aware of this risk and 23.1% admitting to being totally unaware of this risk. (Fig. 2 ) Discussion Tetracycline constitute a group of broad spectrum antibiotics that has over the years demonstrated its efficacy in handling both gram positive and gram negative organisms, through its bacteriostatic activity against the infective pathogens [ 1 ]. Despite its effectiveness, its incompatibility for use among pregnant women has been well established, due to the inherent side effects and risks associated with its usage, especially during the critical period of pregnancy [ 1 ]. This fact has also been backed by the FDA’s classification of tetracycline as a category D drug, [ 4 ] due its impact on foetal development. However this has not deterred its usage as seen with the prevalence of tetracycline tooth discolouration in Nigeria [ 18 , 19 ]. Interventions in communities targeting women has been said to improve the use of drugs [ 20 ], hence, the pregnant women population across all age group, level of education and socio-economic status were target for this study, with most being within the age of 26–30 (31.5%), skilled workers (47.7%) and having tertiary education (60%). This participation is comparable to another study having similar demographic participation as regards knowledge of drug use. [ 16 ] This study showed that many pregnant women had no knowledge of tetracycline induced tooth discolouration occurring in their child if used during pregnancy, with only 21.4% demonstrating good knowledge of this side effect. This finding however differs from results obtained from a previous study [ 14 ], which showed that 40.0% of its respondents with knowledge, on the tooth discolouring implications of tetracycline use. This finding may be associated with the diverse population used in the study having limited medical knowledge and poor drug information, as posited by previous studies [ 24 , 25 ] that there is generally poor knowledge about antibiotics among the public. The prevalence of self-medicating habit among the participants was 54.6%. While this is a similarly high observation to those found in a previous study [ 10 , 11 ], it is however not the same as seen in another study which placed the self-medication rate at 31% [ 9 ]. The difference may be due the smaller sample size used as well as a difference in research methodology. The self-medicating rate of tetracycline among the participants is 10%, comparatively higher than what was observed in previous studies [ 7 , 8 ]. This difference may be due to the number of participants used in this study as well as the objective of this study, considering tetracycline as an individual subset of a bigger entity of antibiotics compared to that of previous studies. Associating the use of tetracycline in pregnancy with socio-demographic factors such as level of education, a statistically significant association was observed, with a p = 0.001. The study showed higher tetracycline self-medication rate among women with no formal education (41.7%), similar to the finding seen in a previous study [ 16 ]. Other findings showed that first trimester was the most common time of use during pregnancy, similar to previous study [ 22 ] showing that pregnant women were aware of the limited risk with antibiotic usage in the first trimester of pregnancy. The most chosen reason for self-medication on this drug was observed to be because of its previous suggestion by family members, which may be associated to the poor knowledge levels about antibiotics and drugs among the general public[ 24 , 25 ]. The most common sources are road side shops, which further reiterates the poor regulation of over the counter medication in the country [ 24 ], with pharmacists and family and friends being the most common source of information on the dosage use among the study participants. In assessing the risk awareness of pregnant women about using tetracycline in pregnancy, this study showed that majority of the women 45.4% are very aware about the risk associated with using tetracycline in pregnancy. However, an Ethiopian study [ 25 ] showed a higher risk awareness of 70%, though this was reported as being an exaggerated awareness. Limitations The empirical findings of this study should however be considered in the light of some limitations to the extrapolation of these findings to that of the general population. The sample size used for this study is small and may show a prevalence that does not reflect the actual level of tetracycline self-medication among the participants. This is however as a result of the limited time allocated to the conducting of this study. Hence future studies may consider using a larger sample size that ensures the result obtained is representative of the general population. The study being carried out solely in a single centre is also a limitation that reduces the generalised representation of the results. Hence, future studies can be conducted as a multi-centre study involving both primary health centres and local birth homes that cater for pregnant women in rural areas. However, the use of pre-tested data collection instruments shows the reliability of the study results, coupled with strict adherence to the research protocol. Conclusion The administration of tetracycline during pregnancy is a decision that necessitates a careful evaluation of risks versus benefits, particularly given that there are several safer alternatives available for pregnant women. Tetracycline's ability to cross the placental barrier and reach the foetus has led to its classification as a category D drug regarding pregnancy safety. Nevertheless, its use among pregnant women persists, as evidenced by the prevalence of tetracycline-induced tooth discoloration observed in patients at restorative dentistry clinics in various tertiary hospitals across Nigeria. This trend can be attributed to the high rate of self-medication among pregnant women, as demonstrated by this study and corroborated by previous research. Additionally, the study reveals that while pregnant women are generally aware of the risks associated with tetracycline use during pregnancy, they often lack knowledge about its potential to cause tooth discoloration. This lack of awareness may contribute to the continued self-administration of tetracycline despite its known risks. The study highlights the prevalent issue of no knowledge and self-medication with tetracycline among pregnant women of low socio-economic status, particularly those without formal education. This finding suggests a critical need for further research involving primary health centres in rural settings and local birth homes, where community health workers, midwives, or traditional birth attendants provide care. These caregivers often lack awareness of drug categories deemed unsafe during pregnancy. Conducting such studies would help corroborate the association between low socio-economic status and tetracycline use during pregnancy, as identified in this study. Moreover, integrating the family dentists into antenatal care sensitization programs for pregnant women is essential. These programs should emphasize the dangers of irrational tetracycline use, including the risk of tooth discoloration and other oral health issues in the developing foetus. Such knowledge is crucial to prevent the psychological impact on children who may develop discoloured teeth, thereby deterring pregnant women from using tetracycline without medical prescription. This multidisciplinary approach could significantly reduce the incidence of tetracycline self-medication and its associated risks in pregnancy. Abbreviations UPTH University of Port Harcourt Teaching Hospital FDA United States Food and Drug Administration SPSS Statistical Product and Service Solution Declarations Acknowledgement The authors would like to acknowledge all the pregnant women at the Obstetrics and Gynaecology department in UPTH that consented to participating in this study, as well as the Head of Department for his swift cooperation during the data collection stage of this study. Author Contribution HOC: was involved in the conception of research ideas, study design, data collection, analysis and interpretation, and was a major contributor to writing the manuscript. BO: was involved in the literature review, study design, data analysis and final revision of the manuscript. Funding No external source of funding. This study was self-sponsored. Data availability The datasets used and or analysed during the current study are available from the corresponding author on reasonable request. Declarations Ethics approval and consent to participate This study adhered to the Helsinki Declaration on medical research involving human participants. Ethical clearance was obtained from the Health Research Ethics Committee through the head of Ethics and Research, UPTH. The ethical clearance reference number was (UPTH/REC/VOL.II/2024/056). The purpose of the study was explained to each participant, after which a signed informed consent form was obtained. Clinical Trial Number Not Applicable Consent for publication Not Applicable Author Details Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Nigeria, [email protected] https://orcid.org/0009-0007-9080-9362 References Dathe K, Schaefer C. The Use of Medication in Pregnancy. Deutsches Aerzteblatt Online [Internet]. 2019 Nov 15 [cited 2024 Jul 20];116(46). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935972/ Sanchez AR, Rogers RS, Sheridan PJ. 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Self-Medication: Potential Risks and Hazards among Pregnant Women in Uyo, Nigeria. The Pan African Medical Journal [Internet]. 2012 [cited 2024 Feb 24];13(15):15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3527026/ Onyedinefu A, Osuagwu GO. The Use of Over-The-Counter Drugs and Its Health Implications in Awka South LGA, Anambra State, Nigeria. Journal of Mathematics Instruction, Social Research and Opinion [Internet]. 2024 [cited 2025 Jul 1];3(2):189–202. Available from: https://doi.org/10.58421/misro.v3i2.227 Tefera YG, Gebresillassie BM, Getnet Mersha A, Belachew SA. Beliefs and Risk Awareness on Medications among Pregnant Women Attending the Antenatal Care Unit in Ethiopia University Hospital. Overestimating the Risks Is Another Dread. Frontiers in Public Health [Internet]. 2020 [cited 2025 Jul 1];8:28. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32195214 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7023176","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":481486297,"identity":"afed4732-22ba-4aea-b85c-ea7c90b55670","order_by":0,"name":"Henry Obiora Chukwudi","email":"data:image/png;base64,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","orcid":"","institution":"University of Port Harcourt","correspondingAuthor":true,"prefix":"","firstName":"Henry","middleName":"Obiora","lastName":"Chukwudi","suffix":""},{"id":481486298,"identity":"92da1b4b-a9b1-4bf0-aada-84611eebbe0e","order_by":1,"name":"Babatope Osagbemiro","email":"","orcid":"","institution":"University of Port Harcourt","correspondingAuthor":false,"prefix":"","firstName":"Babatope","middleName":"","lastName":"Osagbemiro","suffix":""}],"badges":[],"createdAt":"2025-07-01 19:38:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7023176/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7023176/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86309967,"identity":"bf7c4b83-7d2b-45c2-a8e5-1025353899fe","added_by":"auto","created_at":"2025-07-09 08:00:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":14628,"visible":true,"origin":"","legend":"\u003cp\u003eKnowledge about Tetracycline-Induced Tooth Discolouration\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7023176/v1/8cc288ec319863bf93a1c335.png"},{"id":86309970,"identity":"5e1dfcee-c5f9-4c44-939e-9fb4df04c52b","added_by":"auto","created_at":"2025-07-09 08:00:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":15313,"visible":true,"origin":"","legend":"\u003cp\u003eRisk Awareness about Tetracycline-Induced Tooth Discolouration\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7023176/v1/52b3db740150be7a27811fc8.png"},{"id":89472691,"identity":"8b2001cc-a1a6-4eab-96da-1792bad01575","added_by":"auto","created_at":"2025-08-20 09:47:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":843554,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7023176/v1/5118957e-467b-4f76-9384-9178595723cf.pdf"},{"id":86309973,"identity":"e564fc76-943e-4f42-991e-4f4f5ddd9f46","added_by":"auto","created_at":"2025-07-09 08:00:55","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":39376,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalmaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-7023176/v1/64cdabcb3611f709dffb4c3f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk Awareness about Tetracycline-Induced Tooth Discolouration among Pregnant Women attending the University of Port-Harcourt Teaching Hospital Antenatal Clinic in Nigeria","fulltext":[{"header":"Background","content":"\u003cp\u003eTetracycline constitutes a group of broad-spectrum antibiotics with demonstrated efficacy against both gram-positive and gram-negative organisms, exerting bacteriostatic effects on infective agents.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] The inherent risk associated with the use of tetracycline during pregnancy, notably the occurrence of tooth discolouration has been established in previous studies. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] This adverse effect can occur during pregnancy, particularly around the fourth month of gestation when the calcification process of primary teeth commences. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Thus, careful consideration of the risk-benefit profile before the administration or prescription of tetracycline by healthcare professionals is necessary, given the potential impacts on both maternal and foetal health during the gestation and postnatal periods. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eIn 1979[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], the United States Food and Drug Administration (FDA) introduced a classification system to categorize drug safety levels for use in pregnant women or nursing mothers. While this labelling system has undergone modifications [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], the previous categorization placed drugs into categories A, B, C, D, and X on the basis of established evidence of safety [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Category A denoted drugs with proven safety for use during pregnancy, whereas category X indicated drugs associated with potential teratogenic effects in pregnant women. The safety considerations for drug utilization become particularly critical when addressing the use of antibiotics during pregnancy. Antibiotics, which serve as therapeutic agents against infectious organisms, carry potential risks when used during pregnancy, with tetracycline and its derivatives serving as notable examples. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eTetracycline has an affinity for binding with calcium, resulting in the formation of a complex known as the tetracycline-calcium orthophosphate complex. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] This complex is subsequently deposited at sites of mineralization in teeth and bones during their developmental stages. The discernible impact of tetracycline on foetal development has led to its classification as a category D drug by the U.S. Food and Drug Administration (FDA).[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Despite this designation, the use of tetracycline during pregnancy has been documented. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eA Hungarian study reported a prevalence rate of 0.7% for the use of tetracycline, including its derivatives, oxytetracycline and doxycycline. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Additionally, a multicentre study conducted in Nigeria revealed a higher prevalence rate of doxycycline usage at 6.2%. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eDespite the low prevalence of tetracycline use in various studies, these investigations have often overlooked the potential influence of pregnant women's self-medication practices on their exposure to tetracycline. A qualitative review study conducted in Nigeria highlighted a notable rate of self-medication among pregnant women, with reported prevalence rates of 31%, 66.7% and 72.4%. [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Therefore, there is a compelling rationale for investigating the self-medication behaviours on tetracycline among pregnant women in Nigeria.\u003c/p\u003e\u003cp\u003eIn prior research conducted beyond Nigeria, a heightened level of risk awareness among pregnant women regarding antibiotic use during pregnancy has been demonstrated.[\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] However, these studies generally treated antibiotics as a singular entity, neglecting potential variations in awareness levels pertaining to individual antibiotic agents. A recent investigation conducted within Nigeria, focusing on nursing mothers as its study participants, revealed that fewer than half of the respondents possessed an awareness of the risks associated with the use of tetracycline during childhood. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eIn light of these observations, this study determined the awareness of the risk among pregnant women concerning tetracycline-induced tooth discolouration, awareness of the risk with using tetracycline during pregnancy and the prevalence of tetracycline self-medication among pregnant women.\u003c/p\u003e"},{"header":"Materials and Method","content":"\u003cp\u003e\u003cb\u003eStudy design and Study population.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis was a cross-sectional descriptive study, carried out among pregnant women visiting the antenatal clinic of the Obstetrics and Gynaecology department in the University of Port-Harcourt Teaching Hospital (UPTH), using a specially designed, self-administered questionnaire. Informed consent was taken from each participants before administering the questionnaire, and this was done anonymously so as to ensure that the participants could provide honest and unbiased responses without concerns for breach of confidentiality. The questionnaire was refined through a pre-test conducted among similar population group, to improve language precision and ensure easy comprehension among all participants demography. Each item in the questionnaire was carefully designed to avoid leading questions or suggestive language so as to reduce the possibility for response bias.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample size and Sampling technique\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe sample size was determined using the Cochrane\u0026rsquo;s formula for determining sample size in a population greater than 10, 000. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:n=\\frac{{Z}^{2}p(1-p)}{{d}^{2}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWhere; n\u0026thinsp;=\u0026thinsp;desired sample size\u003c/p\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;Standard normal deviate\u003c/p\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;Expected prevalence\u003c/p\u003e\u003cp\u003eD\u0026thinsp;=\u0026thinsp;Error margin\u003c/p\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;9.2% [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eD\u0026thinsp;=\u0026thinsp;5% (0.05)\u003c/p\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;1.96 (at type 1 error of 5%)\u003cdiv id=\"Equb\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equb\" name=\"EquationSource\"\u003e\n$$\\:n=\\frac{{1.96}^{2}\\:\\times\\:0.092\\:\\left(1-0.092\\right)}{{0.05}^{2}}$$\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Equc\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equc\" name=\"EquationSource\"\u003e\n$$\\:n=128.36\\:\\cong\\:128$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe total number of participants sampled for this study was 130. A convenience sampling was used to select participants for this study. Pregnant women attending the antenatal clinic of the Obstetrics and Gynaecology department in UPTH during the study period were selected consecutively until the sample of 130 was reached.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe questionnaire was distributed among pregnant women seen on each visit day to the clinic from Monday to Friday, from the period of 1st of June, 2024 to 27th of July, 2024. A verbal and written consent was obtained before the questionnaire was filled by the participants.\u003c/p\u003e\u003cp\u003eThe questionnaire given was divided into four sections. Section A was designed to extract the socio-demographic variables such as age, occupation, level of education, marital status, gestational age and number of previous pregnancy. Section B consists of questions aimed at obtaining information on the Tetracycline self-medication habits of pregnant women. Each question required the respondents to tick either a Yes or a No wherever applicable. Section C was designed to extract information on the awareness of pregnant women as regards the risks of using tetracycline in pregnancy. The response gotten was recorded on a 4-point awareness Likert scale, ranging from totally unaware to very aware. Section D was designed to extract information on the awareness of pregnant women about tetracycline induced tooth discolouration in their child if used during pregnancy. To assess the level of knowledge about tetracycline induced tooth discolouration among the participants, five variables were tested, each on a three point Likert scale of false, I don\u0026rsquo;t know and true (questions answered with I don\u0026rsquo;t know and false were given a score of zero and one respectively and those answered as true, a score of two). Thus the highest obtainable score was ten, and consequently those who scored between six and ten were considered as having a good knowledge, those scoring between one and five were considered as having poor knowledge and a score of zero considered as having no knowledge on tetracycline induced tooth discolouration.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThe data collected was analysed using IBM Statistical Product and Service Solution (SPSS) version 27 software for windows. Prior to analysis, a Cronbach\u0026rsquo;s alpha reliability test was used to test the internal consistencies of the responses in the Likert scale, having a score of 0.98, indicating good internal consistency. Categorical variables (Age, Occupation, level of education) was expressed in frequency and percentages. Numerical variables was presented using means and standard deviation. The results was presented in the form of tables and figures. Chi-square test of significance was used to show the association between the level of education, and self-medication on tetracycline among the pregnant women. Variables that failed the chi-square assumption test, Fisher\u0026rsquo;s exact test was used to test the significance. All statistical significances were assumed at p values\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eSocio-demographic characteristics of the study participants.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 130 pregnant women were recruited for this study and complete responses were obtained from all the participants. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, shows the socio-demographic characteristics of the study participants. Age distribution among the study participants, showed most of the participants (n\u0026thinsp;=\u0026thinsp;41, 31.5%) were between the age of 26 to 30 years and the lowest age group (n\u0026thinsp;=\u0026thinsp;6, 4.60%) being between 41 and 45 years. In terms of occupation, most of the participants were skilled workers (n\u0026thinsp;=\u0026thinsp;62, 47.7%), followed by the semi-skilled workers (n\u0026thinsp;=\u0026thinsp;22, 16.9%) and the lowest being the unskilled workers population (n\u0026thinsp;=\u0026thinsp;11, 8.5%). More than half of the study population (n\u0026thinsp;=\u0026thinsp;78, 60%) have completed tertiary education and only (n\u0026thinsp;=\u0026thinsp;12, 9.2%) have no formal education. The Marital status showed that most were married (n\u0026thinsp;=\u0026thinsp;99, 76.2%), with only (n\u0026thinsp;=\u0026thinsp;16 12.3%) being single and (n\u0026thinsp;=\u0026thinsp;15, 11.5%) divorced. The gestational age distribution of participants is such that most of the participants (n\u0026thinsp;=\u0026thinsp;75, 57.7%) were in their second trimester, (n\u0026thinsp;=\u0026thinsp;30, 23.1%) in their first trimester while (n\u0026thinsp;=\u0026thinsp;25, 19.2%) in the third trimester of pregnancy. Among the participants, (n\u0026thinsp;=\u0026thinsp;73, 56.2%) have had two or more pregnancies previously while (n\u0026thinsp;=\u0026thinsp;57, 43.8%) have had one previous pregnancy.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e; Social-demographic distribution of the participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;130)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eAge group (Years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSkilled worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e47.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSemi-skilled worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnskilled worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDependent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eLevel of education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTertiary education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e60.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e76.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGestational age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFirst Trimester\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecond Trimester\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThird Trimester\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNumber of previous pregnancies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOne\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwo or more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSelf-medication habit on tetracycline.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that less than half of the respondents (n\u0026thinsp;=\u0026thinsp;13, 10%) indicated self-medicating on tetracycline during pregnancy, with most doing this during their first trimester (n\u0026thinsp;=\u0026thinsp;12, 9.2%) of pregnancy. They mostly stated that the reason for doing this was because it was previously suggested by a family members (n\u0026thinsp;=\u0026thinsp;9, 6.9%). The common source of this drug were from roadside pharmacy shops (n\u0026thinsp;=\u0026thinsp;10, 7.7%) and dosage gotten from a pharmacist or family and friends (n\u0026thinsp;=\u0026thinsp;6, 4.6%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e; Self-medicating habits among pregnant women\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (N)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHistory of self-medication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e54.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eReason for self-medication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt was previously given to me by a doctor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt was previously given to me by a pharmacist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI always have the drugs at home\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt was previously suggested by family members\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt was previously suggested by friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHave you taken tetracycline during pregnancy, without the doctor telling you to?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e90.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIf yes to the question above, at what time of pregnancy?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFirst Trimester\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecond Trimester\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eIf yes to the question above, reasons for taking tetracycline without the doctor telling you to?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt was previously given to me by a pharmacist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt was previously suggested by family members\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIt was previously suggested by friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eWhere do you get the tetracycline drug?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRoadside pharmacy shops\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLocal chemist shops\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHow did you know the dosage of tetracycline to use?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI asked a pharmacist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI asked my family and friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrom my last use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the association between pregnant women who self-medicate during pregnancy and self-medicate on tetracycline during pregnancy. Among the women that self-medicate during pregnancy, n\u0026thinsp;=\u0026thinsp;13, 18.3% of the participants indicated self-medicating on tetracycline during pregnancy.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation between the self-medicating habit of pregnant women and tetracycline use among pregnant women\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eDo you take drugs without the doctor telling you to?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHave you taken tetracycline during pregnancy, without the doctor telling you to?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (18.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58 (83.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA chi square analysis was done to test the association between the level of education of the respondents and use of tetracycline among pregnant women. The result showed that 41.7% (n\u0026thinsp;=\u0026thinsp;5) of those with no formal education self-medicate with tetracycline during pregnancy compared to 2.6% (n\u0026thinsp;=\u0026thinsp;2) of those with tertiary education this was statistically significant with p\u0026thinsp;=\u0026thinsp;0.001 (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation between level of education and use of tetracycline among pregnant women\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eHave you taken tetracycline during pregnancy, without the doctor telling you to?\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eLevel of education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (41.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (58.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (13.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (86.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (16.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (84.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTertiary education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (2.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76 (97.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e117 (90%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003ep- value\u0026thinsp;=\u0026thinsp;0.001 Phi effect size\u0026thinsp;=\u0026thinsp;0.386\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eKnowledge about Tetracycline-Induced Tooth Discolouration\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, depicts the level of knowledge of pregnant women, regarding the risk of tetracycline-induced tooth discolouration occurring in their child if used during pregnancy, with 71.5% having no knowledge, 21.4% having a good knowledge and 7.1% having a poor knowledge about tetracycline-induced tooth discolouration.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eRisk Awareness about Tetracycline-Induced Tooth Discolouration\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWith regards to the risk awareness of its unsafety for use in pregnancy, 59% of the respondents admitted to being very aware of this risk and 23.1% admitting to being totally unaware of this risk. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTetracycline constitute a group of broad spectrum antibiotics that has over the years demonstrated its efficacy in handling both gram positive and gram negative organisms, through its bacteriostatic activity against the infective pathogens [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite its effectiveness, its incompatibility for use among pregnant women has been well established, due to the inherent side effects and risks associated with its usage, especially during the critical period of pregnancy [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This fact has also been backed by the FDA\u0026rsquo;s classification of tetracycline as a category D drug, [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] due its impact on foetal development. However this has not deterred its usage as seen with the prevalence of tetracycline tooth discolouration in Nigeria [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Interventions in communities targeting women has been said to improve the use of drugs [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], hence, the pregnant women population across all age group, level of education and socio-economic status were target for this study, with most being within the age of 26\u0026ndash;30 (31.5%), skilled workers (47.7%) and having tertiary education (60%). This participation is comparable to another study having similar demographic participation as regards knowledge of drug use. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThis study showed that many pregnant women had no knowledge of tetracycline induced tooth discolouration occurring in their child if used during pregnancy, with only 21.4% demonstrating good knowledge of this side effect. This finding however differs from results obtained from a previous study [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], which showed that 40.0% of its respondents with knowledge, on the tooth discolouring implications of tetracycline use. This finding may be associated with the diverse population used in the study having limited medical knowledge and poor drug information, as posited by previous studies [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] that there is generally poor knowledge about antibiotics among the public.\u003c/p\u003e\u003cp\u003eThe prevalence of self-medicating habit among the participants was 54.6%. While this is a similarly high observation to those found in a previous study [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], it is however not the same as seen in another study which placed the self-medication rate at 31% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The difference may be due the smaller sample size used as well as a difference in research methodology. The self-medicating rate of tetracycline among the participants is 10%, comparatively higher than what was observed in previous studies [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This difference may be due to the number of participants used in this study as well as the objective of this study, considering tetracycline as an individual subset of a bigger entity of antibiotics compared to that of previous studies. Associating the use of tetracycline in pregnancy with socio-demographic factors such as level of education, a statistically significant association was observed, with a p\u0026thinsp;=\u0026thinsp;0.001. The study showed higher tetracycline self-medication rate among women with no formal education (41.7%), similar to the finding seen in a previous study [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Other findings showed that first trimester was the most common time of use during pregnancy, similar to previous study [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] showing that pregnant women were aware of the limited risk with antibiotic usage in the first trimester of pregnancy. The most chosen reason for self-medication on this drug was observed to be because of its previous suggestion by family members, which may be associated to the poor knowledge levels about antibiotics and drugs among the general public[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The most common sources are road side shops, which further reiterates the poor regulation of over the counter medication in the country [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], with pharmacists and family and friends being the most common source of information on the dosage use among the study participants.\u003c/p\u003e\u003cp\u003eIn assessing the risk awareness of pregnant women about using tetracycline in pregnancy, this study showed that majority of the women 45.4% are very aware about the risk associated with using tetracycline in pregnancy. However, an Ethiopian study [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] showed a higher risk awareness of 70%, though this was reported as being an exaggerated awareness.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe empirical findings of this study should however be considered in the light of some limitations to the extrapolation of these findings to that of the general population. The sample size used for this study is small and may show a prevalence that does not reflect the actual level of tetracycline self-medication among the participants. This is however as a result of the limited time allocated to the conducting of this study. Hence future studies may consider using a larger sample size that ensures the result obtained is representative of the general population. The study being carried out solely in a single centre is also a limitation that reduces the generalised representation of the results. Hence, future studies can be conducted as a multi-centre study involving both primary health centres and local birth homes that cater for pregnant women in rural areas. However, the use of pre-tested data collection instruments shows the reliability of the study results, coupled with strict adherence to the research protocol.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe administration of tetracycline during pregnancy is a decision that necessitates a careful evaluation of risks versus benefits, particularly given that there are several safer alternatives available for pregnant women. Tetracycline's ability to cross the placental barrier and reach the foetus has led to its classification as a category D drug regarding pregnancy safety. Nevertheless, its use among pregnant women persists, as evidenced by the prevalence of tetracycline-induced tooth discoloration observed in patients at restorative dentistry clinics in various tertiary hospitals across Nigeria. This trend can be attributed to the high rate of self-medication among pregnant women, as demonstrated by this study and corroborated by previous research. Additionally, the study reveals that while pregnant women are generally aware of the risks associated with tetracycline use during pregnancy, they often lack knowledge about its potential to cause tooth discoloration. This lack of awareness may contribute to the continued self-administration of tetracycline despite its known risks.\u003c/p\u003e\u003cp\u003eThe study highlights the prevalent issue of no knowledge and self-medication with tetracycline among pregnant women of low socio-economic status, particularly those without formal education. This finding suggests a critical need for further research involving primary health centres in rural settings and local birth homes, where community health workers, midwives, or traditional birth attendants provide care. These caregivers often lack awareness of drug categories deemed unsafe during pregnancy. Conducting such studies would help corroborate the association between low socio-economic status and tetracycline use during pregnancy, as identified in this study.\u003c/p\u003e\u003cp\u003eMoreover, integrating the family dentists into antenatal care sensitization programs for pregnant women is essential. These programs should emphasize the dangers of irrational tetracycline use, including the risk of tooth discoloration and other oral health issues in the developing foetus. Such knowledge is crucial to prevent the psychological impact on children who may develop discoloured teeth, thereby deterring pregnant women from using tetracycline without medical prescription. This multidisciplinary approach could significantly reduce the incidence of tetracycline self-medication and its associated risks in pregnancy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUPTH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUniversity of Port Harcourt Teaching Hospital\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFDA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited States Food and Drug Administration\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStatistical Product and Service Solution\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge all the pregnant women at the Obstetrics and Gynaecology department in UPTH that consented to participating in this study, as well as the Head of Department for his swift cooperation during the data collection stage of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHOC: was involved in the conception of research ideas, study design, data collection, analysis and interpretation, and was a major contributor to writing the manuscript.\u003c/p\u003e\n\u003cp\u003eBO: was involved in the literature review, study design, data analysis and final revision of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo external source of funding. This study was self-sponsored.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study adhered to the Helsinki Declaration on medical research involving human participants. Ethical clearance was obtained from the Health Research Ethics Committee through the head of Ethics and Research, UPTH. The ethical clearance reference number was (UPTH/REC/VOL.II/2024/056). The purpose of the study was explained to each participant, after which a signed informed consent form was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFaculty of Dentistry, College of Health Sciences, University of Port Harcourt, Nigeria, [email protected] https://orcid.org/0009-0007-9080-9362\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDathe K, Schaefer C. The Use of Medication in Pregnancy. Deutsches Aerzteblatt Online [Internet]. 2019 Nov 15 [cited 2024 Jul 20];116(46). 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pubmed/32195214\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pubmed/32195214\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Tetracycline, Tooth discolouration, Pregnancy, Self-medication","lastPublishedDoi":"10.21203/rs.3.rs-7023176/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7023176/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThere are no existing data on the risk awareness of pregnant women regarding the use of tetracycline during pregnancy, particularly concerning tetracycline-induced tooth discolouration. The lack of data, coupled with prior research findings that revealed high self-medication habits among pregnant women in Nigeria, prompted this study. This study aimed to determine the risk awareness of pregnant women about tetracycline induced tooth discolouration, its use in pregnancy and self-mediation of tetracycline among pregnant women.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThe study was a descriptive, cross sectional study that collected data from a convenience sample of pregnant women attending the antenatal clinic of the University of Port-Harcourt Teaching Hospital (UPTH), Nigeria. The data were collected between 3rd June, 2024 and 26th July, 2024. A self-administered questionnaire was used to collect information on sociodemographic characteristics (age, occupation, educational level and number of previous pregnancies), self-medication with tetracycline, and risk awareness of its use in pregnancy and awareness of tetracycline induced tooth discolouration. The data were entered into SPSS (Statistical Package and Software Solutions) Version 26 for Windows, and descriptive analysis and a chi-square test were used to determine the associations between the level of education and self-medication with respect to tetracycline.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong the 130 participants, 71.5% had no knowledge that tetracycline use during pregnancy induced tooth discolouration in the child. Additionally, 30 (23.1%) participants were totally unaware that tetracycline use was contraindicated during pregnancy. In addition, 13 (10.0%) participants reported self-medication with tetracycline and 71 (54.6%) reported self-medication during pregnancy. A chi-square analysis revealed a statistically significant association between the level of education and self-medication with tetracycline.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe poor awareness of tetracycline-induced tooth discolouration among pregnant women attending the antenatal clinic in UPTH raises public health concerns for an increased risk of the unprescribed use of tetracycline. Information sharing about tetracycline-induced discolouration during antenatal clinics may improve awareness, reduce self-medication with tetracycline and address public health concerns of tetracycline-induced tooth discolouration.\u003c/p\u003e","manuscriptTitle":"Risk Awareness about Tetracycline-Induced Tooth Discolouration among Pregnant Women attending the University of Port-Harcourt Teaching Hospital Antenatal Clinic in Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-09 08:00:50","doi":"10.21203/rs.3.rs-7023176/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f9844fbc-8f5c-4cc3-bd11-e5348571b97f","owner":[],"postedDate":"July 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-03T09:53:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-09 08:00:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7023176","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7023176","identity":"rs-7023176","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}