The framework is shown in Figure 2. Figure 2. Beliefs about Medicine questionnaire defined in a necessity and concerns framework. Table 3 shows the agreement, calculated with Cohen’s kappa coefficient between MEMS and the other adherence methods. Only pill count can be established to have good agreement with MEMS. For

the BMQ and the blood level monitoring there is poor agreement between the method and MEMS, κ = 0.110 and 0.129, respectively. Table 3. The agreement between MEMS and other adherence methods. After logistic regression analyses, there were no potential predictors found for poor adherence for none of the applied methods. Discussion In this study we found that adherence in our PCS guided population, defined Inhibitors,research,lifescience,medical as ≥80% of doses taken on schedule, was 86% with MEMS. Compared with MEMS, only pill count had good agreement for adherence. TDM and BMQ were not associated with MEMS. It seems that in daily practice, pill counts can be used instead of MEMS. The Fasudil cost results of our study compared with previous research show that adherence of antidepressants Inhibitors,research,lifescience,medical during

Inhibitors,research,lifescience,medical pregnancy is relatively high, compared with data from nonpregnant women with chronic medication use or the general population with antidepressants [Sawicki et al. 2011; WHO, 2012; Muzina et al. 2011]. Although pill count is a direct and relatively inexpensive way to measure adherence, data may be unreliable because patients can discard pills before visits in order to appear to be following the regime [Osterberg and Blaschke, 2005]. Compared Inhibitors,research,lifescience,medical with MEMS, we found that with using pill counts 93% of our patients were adherent. The value of pill counts in pregnant women in relation to good compliance needs further evaluation in larger studies. The BMQ has only been validated in studies with antidepressants and chronic medications and not during pregnancy [Horne and Weinman, 1999; Menckeberg et al. 2008; Phatak and Thomas, 2006]. Using the BMQ we defined poor adherence for women categorized Inhibitors,research,lifescience,medical in the sceptical and indifferent group, according to Menckeberg and colleagues and Clatworthy and coworkers [Menckeberg et al. 2008; Clatworthy et al. 2009]. We found

that 65% of pregnant women are classified as adherent. It may be that using a dichotomized value, as we did for our study population, Tryptophan synthase does not reflect the method as developed by Horne and Weinman [Horne and Weinman, 1999]. For practical reasons we used an easy method in our population for measuring the adherence with BMQ. The results for the adherence using BMQ compared with MEMS, however showed that the agreement between these methods was poor. This might be because of the dichotomized distribution of the BMQ results. In a general population the BMQ can be an appropriate method to measure the adherence, but unfortunately this was not the case in our population. For healthcare professionals, it may be important to know the beliefs about the antidepressant use, so that they can adjust therapy if necessary.