Documentation of contraception and pregnancy when prescribing potentially teratogenic medications for reproductive-age women

Eleanor Schwarz, Debbie A. Postlethwaite, Yun Yi Hung, Mary Anne Armstrong

Research output: Contribution to journalArticle

65 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)370-376
Number of pages7
JournalAnnals of Internal Medicine
Volume147
Issue number6
DOIs
StatePublished - Sep 18 2007
Externally publishedYes

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Contraception
Documentation
Prescriptions
Pregnancy
Contraceptive Agents
Counseling
Pregnancy Tests
Isotretinoin
Health Maintenance Organizations
International Classification of Diseases
Pregnancy Rate
United States Food and Drug Administration

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Documentation of contraception and pregnancy when prescribing potentially teratogenic medications for reproductive-age women. / Schwarz, Eleanor; Postlethwaite, Debbie A.; Hung, Yun Yi; Armstrong, Mary Anne.

In: Annals of Internal Medicine, Vol. 147, No. 6, 18.09.2007, p. 370-376.

Research output: Contribution to journalArticle

Schwarz, Eleanor ; Postlethwaite, Debbie A. ; Hung, Yun Yi ; Armstrong, Mary Anne. / Documentation of contraception and pregnancy when prescribing potentially teratogenic medications for reproductive-age women. In: Annals of Internal Medicine. 2007 ; Vol. 147, No. 6. pp. 370-376.
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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.",
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