[back] Drugs During Pregnancy Antidepressants (SSRIs, MAOIs, Tricyclics, Tetracyclics)
More on SSRI's and pregnancy
Teratogen: Any agent that can disturb the development of an embryo or fetus.
Teratogens may cause a birth defect in the child. Or a teratogen may halt the
pregnancy outright. The classes of teratogens include radiation, maternal
infections, chemicals, and drugs.
J Gen Intern Med. 2010 Jan 20. [Epub ahead of print]
Providing Contraception for Women Taking Potentially Teratogenic Medications: A Survey of Internal Medicine Physicians' Knowledge, Attitudes and Barriers.
Eisenberg DL, Stika C, Desai A, Baker D, Yost KJ.
Department of Obstetrics & Gynecology, Division of Clinical Research, Washington University in St. Louis School of Medicine, 4533 Clayton Ave, St. Louis, MO, 63110, USA, firstname.lastname@example.org .
BACKGROUND: The majority of women prescribed category D or X medications may not receive adequate contraceptive counseling or a reliable contraceptive method. Physicians who prescribe potentially teratogenic medications have a responsibility to provide women with contraceptive counseling, a method of highly-effective contraception, or both. OBJECTIVE: Investigate the knowledge, beliefs and barriers of primary care physicians toward providing adequate contraception to women taking potential teratogens. DESIGN & PARTICIPANTS: Self-administered confidential survey of primary care internal medicine physicians at an urban, academic medical center. MEASUREMENTS: Knowledge of potential teratogenic medications and contraceptive failure rates was assessed. Participants' beliefs about adequacy of their medical education, practice limitations and attitudes toward improving provision of contraception to women on potential teratogens were assessed. RESULTS: One hundred and ten physicians responded (57.3%). Nearly two-thirds (62.3%) of participants had cared for reproductive aged women taking category D or X medications in the past year. The mean percent of correctly identified category D or X medications was 58.4% (SD 22.1%). The mean percent correct for knowledge of published contraceptive failure rates was 64.6% (SD 23.1%). Most respondents (87.6%) felt it is the responsibility of primary care physicians to provide contraception. Time constraints were reported to be somewhat or very limiting by 61.3% and over half felt medical school (63.2%) or residency (58.1%) inadequately prepared them to prescribe or counsel about contraceptives. CONCLUSIONS: Primary care physicians commonly encounter reproductive age women taking category D or X medications, but may lack sufficient knowledge and time to counsel about potential teratogens and contraception to prevent fetal exposure to these drugs.
Ann Intern Med. 2007 Sep 18;147(6):370-6.
Documentation of contraception and pregnancy when prescribing potentially teratogenic medications for reproductive-age women.
Schwarz EB, Postlethwaite DA, Hung YY, Armstrong MA.
Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. email@example.com
BACKGROUND: Certain medications are identified by the U.S. Food and Drug Administration (FDA) as class D or X because they increase the risk for birth defects if used during pregnancy. OBJECTIVE: To assess pregnancy rates and the frequency of contraceptive counseling documented with prescriptions for class D or X drugs filled by women of reproductive age. DESIGN: Description of prescriptions filled in 2001. SETTING: A large health maintenance organization in northern California in 2001. PATIENTS: 488,175 women age 15 to 44 years who filled a total of 1,011,658 class A, B, D, or X prescriptions. MEASUREMENTS: Medications dispensed, contraceptive counseling, and pregnancy testing. RESULTS: A class D or X prescription was filled by 1 of every 6 women studied. Women who filled a prescription for class D or X medications were no more likely than women who filled prescriptions for safer, class A or B medications to have received contraceptive counseling, filled a contraceptive prescription, or been sterilized (48% vs. 51% of prescriptions). There was little variation by clinical indication in rates of contraceptive counseling with class D or X prescriptions, except for isotretinoin. Women who filled a class D or X prescription were only slightly less likely to have a pregnancy documented within 3 months than women filling a class A or B prescription (1.0% vs. 1.4% of prescriptions). LIMITATIONS: International Classification of Diseases, Ninth Revision, codes underestimate contraceptive counseling. Documentation of a positive pregnancy test after filling a prescription may overestimate medication use in early pregnancy. Women who filled several prescriptions are overrepresented in prescription analyses. CONCLUSION: Prescriptions for potentially teratogenic medications are frequently filled by women of childbearing age without documentation of contraceptive counseling.