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- Title
Documentation of Contraception and Pregnancy When Prescribing Potentially Teratogenic Medications for Reproductive-Age Women.
- Authors
Schwarz, Eleanor Bimla; Postlethwaite, Debbie A.; Yun-Yi Hung; Armstrong, Mary Anne
- Abstract
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 over-represented in prescription analyses. Conclusion: Prescriptions for potentially teratogenic medications are frequently filled by women of childbearing age without documentation of contraceptive counseling.
- Subjects
CALIFORNIA; EFFECT of drugs on reproduction; TERATOGENIC agents; CONTRACEPTIVES; COUNSELING research
- Publication
Annals of Internal Medicine, 2007, Vol 147, Issue 6, p370
- ISSN
0003-4819
- Publication type
Article
- DOI
10.7326/0003-4819-147-6-200709180-00006