Eleanor Bimla Schwarz, MD, MS¹, Judith Maselli², and Ralph Gonzales, MD². (1) General Internal Medicine Section, UC San Francisco, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, 415-750-2093, Schwarz@medicine.ucsf.edu, (2) Department of Medicine, UC San Francisco, 3333 California Ave, San Francisco, CA 94118

One of every 28 babies born in the United States is born with a birth defect. In the majority of cases, the cause of the defect is unknown. Certain medications are known to increase the risk of birth defects. The goal of this study is to identify the potentially teratogenic medications most frequently prescribed to women of reproductive age and the providers who most frequently make these prescriptions. In addition, we explore awareness of the risks of these medications by assessing rates of concurrent contraceptive counseling. METHODS: The 1998-2000 National Ambulatory Medical Care Surveys provide information on 12,681 visits made by women of reproductive age to a national sample of non-federally employed office-based physicians who are primarily engaged in direct patient care. By design, the stratified random sampling strategy allows extrapolation of results to the US population of ambulatory physicians and patients. The primary outcome was defined as an office visit associated with a prescription of a potentially teratogenic medication. A secondary outcome was documentation of contraceptive counseling or prescription of a contraceptive method. RESULTS: One of every twenty-five outpatient prescriptions written for women of reproductive age are for potentially teratogenic medications. Those most frequently prescribed were anxiolytics, anti-seizure medications, antibiotics, and statins. Internists and family/general practitioners wrote ten times as many such prescriptions to women of reproductive age as gynecologists (4.0 million vs 0.4 million annual prescriptions; or 6.4% of visits to generalists vs. 1.6% of visits to gynecologists). Most visits in which a potential teratogen was prescribed had no documentation that contraception was discussed at the same visit. Visits with prescription of a class D or X medication were no more likely to have documentation of concurrent contraceptive counseling than visits with prescription of a class A or B medication (4.1% vs. 5.1%, p=0.24). Increased awareness of the teratogenic risk associated with certain medications and more frequent provision of contraceptive counseling, may decrease the number of children and families who suffer with birth defects. Collection of information about provision of family planning services is essential to an accurate assessment of the risks associated with use of teratogenic medications.

Learning Objectives:

• Identify the potentially teratogenic medications most frequently prescribed to women of reproductive age
• Identify the health care providers who are most frequently writing these prescriptions

Keywords: Birth Defects, Reproductive Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.