Kansas City, MO—Noting that an “alarmingly low” percentage of adult women receive contraceptive provision when they are simultaneously prescribed a known teratogen, University of Missouri-Kansas City researchers sought to determine the extent of the problem when pediatric providers prescribed those types of drugs to adolescent patients.
To do that, they performed a retrospective review of medical records at a Midwestern academic pediatric medical center, examining visits in 2008-2012 by adolescents aged 14 to 25 years in which a known teratogen—FDA pregnancy risk category D or X—was prescribed. The electronic medical records were queried for demographic information, evidence of contraceptive provision, and menstrual and sexual histories. Results were published recently in the journal Pediatrics.
The study found that, among 4,172 clinic visits, 1,694 young women received 4,506 prescriptions for teratogenic medications—most commonly topiramate, methotrexate, diazepam, isotretinoin, and enalapril. Subspecialists most likely to prescribe teratogens were neurologists, hematologist-oncologists, and dermatologists.
Overall, contraceptive provision was documented in just 28.6% of the visits. Race and age both were factors in who received measures to avoid pregnancy; whites versus nonwhites and older versus younger girls were more likely to receive contraceptive provision, according to the study.
The presence of a federal risk mitigation system for the teratogen also increased the likelihood of contraceptive provision, study authors note.
“Our data demonstrate female adolescents prescribed teratogens receive inadequate contraception provision, which could increase their risk for negative pregnancy outcomes,” the researchers point out. “Although the presence of a federal risk mitigation system appears to improve contraceptive provision, these systems are costly and, in some instances, difficult to implement. Efforts to improve provider practices are needed.”
The study notes that it is unknown how often pediatric providers provide reproductive counseling to female adolescents prescribed medications with teratogenic potential.
“Adolescents prescribed known teratogens are receiving suboptimal reproductive health care,” study authors add. “Our data illustrate that provider interventions must focus not only on sexual behaviors and the need for contraceptive care but also should include education regarding teratogenic risk associated with treatment.”
« Click here to return to Weekly News Update.