Developing a Pregnancy-Specific Medication Adherence Scale: Centering the Voices of Pregnant People

Abstract: Background Medication adherence during pregnancy is a critical determinant of maternal and fetal health. However, widely used adherence scales—MMAS-8, PROMIS, and MARS—have not been validated or adapted specifically for pregnant populations. This gap undermines our understanding of how pregnancy-specific barriers (e.g., morning sickness, fetal safety concerns) affect adherence to prescription medications, prenatal vitamins, and supplements. Methods We systematically reviewed and modified the three validated adherence scales through a pregnancy-centered lens. In-depth interviews and expert reviews were conducted with individuals who are currently or were recently pregnant, focusing on both structural and individual-level barriers across the preconception and prenatal periods. Results Several items from existing scales were retained due to universal relevance (e.g., forgetfulness), while new items were added to capture pregnancy-specific challenges—such as aversions from nausea, cultural beliefs, or mistrust regarding medication safety. Preliminary results suggest that standard scales underreport nonadherence driven by pregnancy-related concerns. Conclusion Our proposed pregnancy-specific adherence scale aims to improve measurement precision and intervention design. By capturing nuanced motivations behind adherence behaviors, the scale can inform targeted education, provider counseling, and policy-level efforts to support prenatal health equity—especially among historically underserved populations. Future research will validate the scale across diverse populations and explore its integration into prenatal care systems.