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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.
http://www.medterms.com/script/main/art.asp?articlekey=11315
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, eisenbergd@wustl.edu .
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.
PMID: 20087677
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. schwarzeb@upmc.edu
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.
PMID: 17876020