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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. 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.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Schwarz EB,Postlethwaite DA,Hung YY,Armstrong MA

doi

10.7326/0003-4819-147-6-200709180-00006

subject

Has Abstract

pub_date

2007-09-18 00:00:00

pages

370-6

issue

eissn

0003-4819

issn

1539-3704

pii

147/6/370

journal_volume

147

pub_type

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