Documentation of Contraception and Pregnancy When Prescribing Potentially Teratogenic Medications for Reproductive-Age Women
Publication: Annals of Internal Medicine
Volume 147, Number 6
Submit a Comment
Contributors must reveal any conflict of interest. Comments are moderated. Please see our information for authorsregarding comments on an Annals publication.
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 overrepresented in prescription analyses.
Conclusion:
Prescriptions for potentially teratogenic medications are frequently filled by women of childbearing age without documentation of contraceptive counseling.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
U.S. Food and Drug Administration. Code of Federal Regulations, Title 21. 4 Washington, DC: U.S. Government Printing Office; 2003.
2.
Schwarz EB, Maselli J, Norton M, Gonzales R. Prescription of teratogenic medications in United States ambulatory practices. Am J Med. 2005;118:1240-9. [PMID: 16271908]
3.
Andrade SE, Gurwitz JH, Davis RL, Chan KA, Finkelstein JA, Fortman K, et al. Prescription drug use in pregnancy. Am J Obstet Gynecol. 2004;191:398-407. [PMID: 15343213]
4.
Lee E, Maneno MK, Smith L, Weiss SR, Zuckerman IH, Wutoh AK, et al. National patterns of medication use during pregnancy. Pharmacoepidemiol Drug Saf. 2006;15:537-45. [PMID: 16700083]
5.
Sanz E, Gómez-López T, Martínez-Quintas MJ. Perception of teratogenic risk of common medicines. Eur J Obstet Gynecol Reprod Biol. 2001;95:127-31. [PMID: 11267734]
6.
Pole M, Einarson A, Pairaudeau N, Einarson T, Koren G. Drug labeling and risk perceptions of teratogenicity: a survey of pregnant Canadian women and their health professionals. J Clin Pharmacol. 2000;40:573-7. [PMID: 10868307]
7.
Bankole A, Singh S, Haas T. Reasons why women have induced abortions: evidence from 27 countries. Int Fam Plan Perspect. 1998;24:117-27.
8.
Kaiser Permanente. Kaiser Health Plan Benefit and Policy Development. Oakland, CA: Kaiser Permanente; 2006.
9.
Wilson JG, Brent RL. Are female sex hormones teratogenic? Am J Obstet Gynecol. 1981;141:567-80. [PMID: 6271011]
10.
Thomson Micromedex Healthcare Series. Accessed at www.thomsonhc.com/hcs/librarian on 3 April 2007.
11.
Physician's Desk Reference. 60th ed. Oradell, NJ: Medical Economics; 2006.
12.
Briggs GG, Freeman RG, Yaffe SJ. Drugs in Pregnancy and Lactation. Philadelphia: Lippincott Williams & Wilkins; 2002.
13.
Cooper WO, Hernandez-Diaz S, Arbogast PG, Dudley JA, Dyer S, Gideon PS, et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med. 2006;354:2443-51. [PMID: 16760444]
14.
Weisman CS, Maccannon DS, Henderson JT, Shortridge E, Orso CL. Contraceptive counseling in managed care: preventing unintended pregnancy in adults. Womens Health Issues. 2002;12:79-95. [PMID: 11879761]
15.
Trussell J. Contraceptive failure in the United States. Contraception. 2004;70:89-96. [PMID: 15288211]
16.
Mercer Human Resources Consulting. Women's Health Care: Understanding the Cost and Value of Contraceptive Benefits. New York: Mercer Human Resources Consulting; 2005.
17.
Addis A, Sharabi S, Bonati M. Risk classification systems for drug use during pregnancy: are they a reliable source of information? Drug Saf. 2000;23:245-53. [PMID: 11005706]
18.
Sannerstedt R, Lundborg P, Danielsson BR, Kihlström I, Alván G, Prame B, et al. Drugs during pregnancy: an issue of risk classification and information to prescribers. Drug Saf. 1996;14:69-77. [PMID: 8852521]
19.
Trussell J, Vaughan B. Contraceptive failure, method-related discontinuation and resumption of use: results from the 1995 National Survey of Family Growth. Fam Plann Perspect. 1999;31:64-72, 93. [PMID: 10224544]
20.
Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006;38:90-6. [PMID: 16772190]
21.
Centers for Disease Control and Prevention (CDC). Improved national prevalence estimates for 18 selected major birth defects—United States, 1999-2001. MMWR Morb Mortal Wkly Rep. 2006;54:1301-5. [PMID: 16397457]
Information & Authors
Information
Published In
Annals of Internal Medicine
Volume 147 • Number 6 • 18 September 2007
Pages: 370 - 376
History
Published online: 18 September 2007
Published in issue: 18 September 2007
Keywords
Copyright
© 2007 American College of Physicians.
Authors
Metrics & Citations
Metrics
Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. For an editable text file, please select Medlars format which will download as a .txt file. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
Download article citation data for:
Documentation of Contraception and Pregnancy When Prescribing Potentially Teratogenic Medications for Reproductive-Age Women. Ann Intern Med.2007;147:370-376. [Epub 18 September 2007]. doi:10.7326/0003-4819-147-6-200709180-00006
Documentation of Contraception and Pregnancy When Prescribing Potentially Teratogenic Medications for Reproductive-Age Women. Ann Intern Med.2007;147:370-376. [Epub 18 September 2007]. doi:10.7326/0003-4819-147-6-200709180-00006
View More
Login Options:
Purchase
You will be redirected to acponline.org to sign-in to Annals to complete your purchase.
Access to EPUBs and PDFs for FREE Annals content requires users to be registered and logged in. A subscription is not required. You can create a free account below or from the following link. You will be redirected to acponline.org to create an account that will provide access to Annals. If you are accessing the Free Annals content via your institution's access, registration is not required.
Create your Free Account
You will be redirected to acponline.org to create an account that will provide access to Annals.
Comments
0 Comments