Abstract
Aim: To systematically identify studies of implementing risk management
measures when prescribing teratogenic medicines for women of child
bearing 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 counselling, contraceptive counselling,
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 counselling
(9.5-99.3%), contraceptive counselling (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/gynaecologists), for etretinate (by pregnant
women), and for misoprostol (by pregnant and non-pregnant women). An
under-estimation was reported for warfarin and retinoids (by general
practitioners and obstetric/gynaecologists). 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 child bearing age is
reported in the literature. A common tendency to over-estimate the risk
of teratogenic medications was evident.