Provision of potentially teratogenic medications to female veterans of childbearing age

Eleanor Schwarz, Lisa S. Longo, Xinhua Zhao, Roslyn A. Stone, Francesca Cunningham, Chester B. Good

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Certain medications increase the risk of birth defects whether used during pregnancy or immediately preconception. Objectives: To describe dispensing of potentially teratogenic medications (Food and Drug Administration classes D or X) to female Veterans treated by the Veterans Affairs (VA) Healthcare System, and assess whether documented provision of family planning services is more common when potentially teratogenic medications are prescribed. Research Design: We examined all 2,634,441 prescriptions filled in fiscal year 2007 or 2008 by 78,232 female Veterans, aged 18 to 45, who made ≥2 visits to VA clinics within the year prior to medication dispensing from VA pharmacies. Measures: Medications dispensed, contraceptive counseling, and pregnancy testing. Results: Prescriptions for potentially teratogenic medications were filled by 48.8% of female Veterans who received medications from a VA pharmacy. Women who filled prescriptions for potentially teratogenic medications were only slightly more likely to have documented family planning services (eg, contraception, contraceptive counseling, or pregnancy testing) than women who filled class C, but not class D or X, prescriptions (55.7% vs. 51.8%). Women filling only class A or B prescriptions were least likely to have documented family planning services (35.9%). Among women dispensed potentially teratogenic medications, family planning services were significantly more likely to be documented for women who were ≥25 years (odds ratio [OR], 2.82; 95% confidence interval [CI], 2.57-3.11), unmarried (OR, 1.30; 95% CI, 1.23-1.35), non-White (OR, 1.17; 95% CI, 1.09-1.26), seen at a womens clinic (OR, 1.96; 95% CI, 1.88-2.05), received a retinoid medication (OR, 7.72; 95% CI, 3.02-19.7), or had serious mental illness (OR, 1.26; 95% CI, 1.18-1.34). Conclusions: Medications that may cause birth defects if used during pregnancy are dispensed frequently to female Veterans by VA pharmacies without documented receipt of contraceptive counseling or pregnancy testing.

Original languageEnglish (US)
Pages (from-to)834-842
Number of pages9
JournalMedical Care
Volume48
Issue number9
DOIs
StatePublished - Sep 1 2010
Externally publishedYes

Fingerprint

Veterans
Odds Ratio
Prescriptions
Family Planning Services
Confidence Intervals
Pregnancy
Contraceptive Agents
Counseling
Pharmacies
Retinoids
United States Food and Drug Administration
Contraception
Research Design
Delivery of Health Care

Keywords

  • contraception
  • medication safety
  • preconception counseling
  • women

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Provision of potentially teratogenic medications to female veterans of childbearing age. / Schwarz, Eleanor; Longo, Lisa S.; Zhao, Xinhua; Stone, Roslyn A.; Cunningham, Francesca; Good, Chester B.

In: Medical Care, Vol. 48, No. 9, 01.09.2010, p. 834-842.

Research output: Contribution to journalArticle

Schwarz, Eleanor ; Longo, Lisa S. ; Zhao, Xinhua ; Stone, Roslyn A. ; Cunningham, Francesca ; Good, Chester B. / Provision of potentially teratogenic medications to female veterans of childbearing age. In: Medical Care. 2010 ; Vol. 48, No. 9. pp. 834-842.
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abstract = "Background: Certain medications increase the risk of birth defects whether used during pregnancy or immediately preconception. Objectives: To describe dispensing of potentially teratogenic medications (Food and Drug Administration classes D or X) to female Veterans treated by the Veterans Affairs (VA) Healthcare System, and assess whether documented provision of family planning services is more common when potentially teratogenic medications are prescribed. Research Design: We examined all 2,634,441 prescriptions filled in fiscal year 2007 or 2008 by 78,232 female Veterans, aged 18 to 45, who made ≥2 visits to VA clinics within the year prior to medication dispensing from VA pharmacies. Measures: Medications dispensed, contraceptive counseling, and pregnancy testing. Results: Prescriptions for potentially teratogenic medications were filled by 48.8{\%} of female Veterans who received medications from a VA pharmacy. Women who filled prescriptions for potentially teratogenic medications were only slightly more likely to have documented family planning services (eg, contraception, contraceptive counseling, or pregnancy testing) than women who filled class C, but not class D or X, prescriptions (55.7{\%} vs. 51.8{\%}). Women filling only class A or B prescriptions were least likely to have documented family planning services (35.9{\%}). Among women dispensed potentially teratogenic medications, family planning services were significantly more likely to be documented for women who were ≥25 years (odds ratio [OR], 2.82; 95{\%} confidence interval [CI], 2.57-3.11), unmarried (OR, 1.30; 95{\%} CI, 1.23-1.35), non-White (OR, 1.17; 95{\%} CI, 1.09-1.26), seen at a womens clinic (OR, 1.96; 95{\%} CI, 1.88-2.05), received a retinoid medication (OR, 7.72; 95{\%} CI, 3.02-19.7), or had serious mental illness (OR, 1.26; 95{\%} CI, 1.18-1.34). Conclusions: Medications that may cause birth defects if used during pregnancy are dispensed frequently to female Veterans by VA pharmacies without documented receipt of contraceptive counseling or pregnancy testing.",
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AU - Good, Chester B.

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N2 - Background: Certain medications increase the risk of birth defects whether used during pregnancy or immediately preconception. Objectives: To describe dispensing of potentially teratogenic medications (Food and Drug Administration classes D or X) to female Veterans treated by the Veterans Affairs (VA) Healthcare System, and assess whether documented provision of family planning services is more common when potentially teratogenic medications are prescribed. Research Design: We examined all 2,634,441 prescriptions filled in fiscal year 2007 or 2008 by 78,232 female Veterans, aged 18 to 45, who made ≥2 visits to VA clinics within the year prior to medication dispensing from VA pharmacies. Measures: Medications dispensed, contraceptive counseling, and pregnancy testing. Results: Prescriptions for potentially teratogenic medications were filled by 48.8% of female Veterans who received medications from a VA pharmacy. Women who filled prescriptions for potentially teratogenic medications were only slightly more likely to have documented family planning services (eg, contraception, contraceptive counseling, or pregnancy testing) than women who filled class C, but not class D or X, prescriptions (55.7% vs. 51.8%). Women filling only class A or B prescriptions were least likely to have documented family planning services (35.9%). Among women dispensed potentially teratogenic medications, family planning services were significantly more likely to be documented for women who were ≥25 years (odds ratio [OR], 2.82; 95% confidence interval [CI], 2.57-3.11), unmarried (OR, 1.30; 95% CI, 1.23-1.35), non-White (OR, 1.17; 95% CI, 1.09-1.26), seen at a womens clinic (OR, 1.96; 95% CI, 1.88-2.05), received a retinoid medication (OR, 7.72; 95% CI, 3.02-19.7), or had serious mental illness (OR, 1.26; 95% CI, 1.18-1.34). Conclusions: Medications that may cause birth defects if used during pregnancy are dispensed frequently to female Veterans by VA pharmacies without documented receipt of contraceptive counseling or pregnancy testing.

AB - Background: Certain medications increase the risk of birth defects whether used during pregnancy or immediately preconception. Objectives: To describe dispensing of potentially teratogenic medications (Food and Drug Administration classes D or X) to female Veterans treated by the Veterans Affairs (VA) Healthcare System, and assess whether documented provision of family planning services is more common when potentially teratogenic medications are prescribed. Research Design: We examined all 2,634,441 prescriptions filled in fiscal year 2007 or 2008 by 78,232 female Veterans, aged 18 to 45, who made ≥2 visits to VA clinics within the year prior to medication dispensing from VA pharmacies. Measures: Medications dispensed, contraceptive counseling, and pregnancy testing. Results: Prescriptions for potentially teratogenic medications were filled by 48.8% of female Veterans who received medications from a VA pharmacy. Women who filled prescriptions for potentially teratogenic medications were only slightly more likely to have documented family planning services (eg, contraception, contraceptive counseling, or pregnancy testing) than women who filled class C, but not class D or X, prescriptions (55.7% vs. 51.8%). Women filling only class A or B prescriptions were least likely to have documented family planning services (35.9%). Among women dispensed potentially teratogenic medications, family planning services were significantly more likely to be documented for women who were ≥25 years (odds ratio [OR], 2.82; 95% confidence interval [CI], 2.57-3.11), unmarried (OR, 1.30; 95% CI, 1.23-1.35), non-White (OR, 1.17; 95% CI, 1.09-1.26), seen at a womens clinic (OR, 1.96; 95% CI, 1.88-2.05), received a retinoid medication (OR, 7.72; 95% CI, 3.02-19.7), or had serious mental illness (OR, 1.26; 95% CI, 1.18-1.34). Conclusions: Medications that may cause birth defects if used during pregnancy are dispensed frequently to female Veterans by VA pharmacies without documented receipt of contraceptive counseling or pregnancy testing.

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