Documentation of Contraception and Pregnancy When Prescribing Potentially Teratogenic Medications for Reproductive-Age Women

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.

Contraceptive Provision to Adolescent Females Prescribed Teratogenic Medications

“…To communicate the potential teratogenic risk of a medication to the prescriber, the US Food and Drug Administration (FDA) currently uses an evidence-based grading system as part of product labeling that categorizes medications by potential for teratogenic risk (eg, category A are those with no demonstrated risk, categories D and X are those associated with definite risk and positive evidence of fetal harm). 1 Several studies of family and internal medicine providers demonstrated low rates (20%-48%) of contraception provision among females of reproductive age prescribed teratogens. [1][2][3][4] However, no previous study has evaluated practices among pediatric providers or examined rates of documentation of sexual history or menstrual history in adolescents prescribed teratogens.…”

“…1 Several studies of family and internal medicine providers demonstrated low rates (20%-48%) of contraception provision among females of reproductive age prescribed teratogens. [1][2][3][4] However, no previous study has evaluated practices among pediatric providers or examined rates of documentation of sexual history or menstrual history in adolescents prescribed teratogens. To address this knowledge gap, we conducted a targeted, retrospective assessment of contraception provision in a large cohort of adolescent females prescribed potential teratogens.…”

Gravidez, Aleitamento e Fármacos em Dermatologia - Tratamento Sistémico

“…11,12 No caso particular da isotretinoína, considerada o retinói-de de eleição em mulheres em idade fértil, recomenda-se a exclusão da gravidez antes do início do tratamento, a utilização em simultâneo de duas formas de contraceção durante o tratamento, a execução de testes de gravidez sempre que ocorrer alguma falha nas medidas contracetivas e que se adie qualquer tentativa de engravidar até pelo menos três meses desde a sua suspensão. 13,14 O uso de isotretinoína durante o aleitamento está também contra-indicado pois as concentrações no leite são significativas. 15 Em virtude da sua imaturidade renal e hepática, os níveis séricos nos lactentes poderiam atingir níveis tóxicos, predispondo a complicações como hepatotoxicidade, aumento da pressão intracraniana, dores ósseas e articulares, e aumento do risco de infeção respiratória.…”

Safe Use of Drugs During Pregnancy in Focus of International Practice of Pharmacovigilance System and Teratological Information Service Organization

“…В таких случаях требуется информировать женщин не только о частоте и тяжести тератогенных эффектов, но также об альтернативной терапии с менее выражен-ными фетальными эффектами. Продемонстрировано, что врачебная консультация по поводу применения кон-трацептивов может способствовать увеличению знаний женщин о связанных с беременностью рисках, изменяя их поведение и уменьшая экспозицию тератогенами во время беременности [34,35]. Однако, в ряде работ это не нашло подтверждения для улучшения исходов беременности [36,37].…”