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Risk management of teratogenic medicines: A systematic review
Author(s) -
Shroukh Wejdan A.,
Steinke Douglas T.,
Willis Sarah C.
Publication year - 2020
Publication title -
birth defects research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.845
H-Index - 17
ISSN - 2472-1727
DOI - 10.1002/bdr2.1799
Subject(s) - medicine , pregnancy , obstetrics , thalidomide , family medicine , gynecology , genetics , multiple myeloma , biology
Abstract Aim To systematically identify studies of implementing risk management measures when prescribing teratogenic medicines for women of childbearing age and studies reporting risk perceptions of teratogenic medications. Methods MEDLINE, CINAHL, Scopus, EMBASE, and International Pharmaceutical Abstracts were searched. Studies were included in the risk management section if they reported any of the following risk management measures: teratogenic counseling, contraceptive counseling, pregnancy testing before starting treatment, pregnancy testing during treatment, use of contraception before starting treatment, and use of contraception during treatment. Studies were included in the perceptions section if they reported perceived teratogenic risk as numerical value. Results Fifty‐five studies were included in the risk management section and seven studies were included in the perceptions sections. Prevalence of risk management measures varied as follows: teratogenic counseling (9.5%–99.3%), contraceptive counseling (6.1%–98%), pregnancy testing before starting treatment (0%–95.1%), pregnancy testing during treatment (12.7%–100%), contraception use before starting treatment (15.7%–94%), and contraception use during treatment (1.7%–100%). A proper estimation of the teratogenic risk was reported for thalidomide (by general practitioners and obstetric/gynecologists), for etretinate (by pregnant women), and for misoprostol (by pregnant and nonpregnant women). An under‐estimation was reported for warfarin and retinoids (by general practitioners and obstetric/gynecologists). And over‐estimation was reported for thalidomide, valproate, lithium, isotretinoin, phenytoin, warfarin and etretinate by different populations. Conclusion Considerable variation in the implementation of risk management measures when prescribing teratogenic medicines to women of childbearing age is reported in the literature. A common tendency to over‐estimate the risk of teratogenic medications was evident.