Perceptions of teratogenic risk
To help patients get the most from their treatment, it is important that
their experience of medication use be explored and understood. In recent
years, there has been an increasing interest in research on the
perception of teratogenic risk [16]. This is corroborated by results
of the current review, which shows that all papers included were
published only in the last two decades. Additionally, the relatively
small number of studies included in the review (seven studies) indicates
that the study of perceptions of teratogenic risk is an important area
for further research.
Two methods were used to measure the perception of teratogenic risk of
participants, and those were either a numeric scale [15, 24, 79, 80,
82] or a visual analogue scale [16, 81]. One major issue regarding
the use of a numeric scale to estimate the risk is its dependence on
numeracy skills of participants [82, 94]. Evidence from the
literature shows that correct estimation and understanding of health
related risk information is significantly correlated with an ability to
understand numbers and mathematical concepts [94, 95]. The second
method to measure the perception of teratogenic risk was the use of a
visual analogue scale. There is an ongoing debate on the utility of
visual analogue scales in measuring risk perception. Some argue that
responses of participants to questions including a visual analogue scale
tend to cluster around the middle point of the scale and might
over-estimate the risk when it is low [16, 96], while others suggest
that a visual analogue scale can provide a wide range of responses that
can be chosen by research participants [97]. Pons et al.
investigated the level of agreement between a visual analogue scale and
a numeric scale in estimating the teratogenic risk. In their research,
they concluded that there was no agreement between the two methods in
estimating teratogenic risk. [96]. Furthermore, it is recommended
that future research exploring perceptions of teratogenic risk needs to
utilise qualitative methods in addition to quantitative research. This
is one way to overcome the ongoing controversy regarding how to reliably
measure perception of teratogenic risk and will provide a deeper
understanding of how risk is perceived [92].
It is clear from the results of the review that teratogenic risk of
medications tends to be over-estimated [16, 24, 79-81], while proper
estimation [15, 82] or under-estimation [15] occurs less
frequently. Yet while there is agreement in the literature about the
difficulty of understanding the teratogenic risk of medications due to
scientific uncertainty [98, 99], a realistic perception of
teratogenic risk is needed by women in child bearing age to adhere to
their therapy [100].
Over-estimating the teratogenic risk of medications might be due to
several factors. For women, pregnancy is viewed as a sensitive phase of
their lives which can be easily adversely affected by exposure to a
number of teratogens (such as alcohol) and including medications. In
addition, pregnancy entails a significant responsibility to the mother
to keep her foetus as safe as possible. These attitudes are further
emphasized by social norms and cultural beliefs and can affect women’s
ideas about medications [13, 98, 101]. On the other hand, for health
care professionals and particularly for physicians, exaggerating the
teratogenic risk of medications can be a result of inadequate knowledge,
which in turn might be the result of insufficient training and education
provided for physicians [81], or the lack of relevant resources
being utilized when needed [102]. Furthermore, physicians’ fear of
legal liability or possible accusation of malpractice if anything goes
wrong while prescribing a potential teratogen might underpin this over
estimation of the teratogenic risk of medications [102].
Subsequently, future research needs to focus on understanding how
teratogenic risk is conceptualised and the reasons behind the tendency
to exaggerate it.
The strength of this review relies in being the first attempt to shed
light on the current status of implementing risk management measures
when teratogenic medications are prescribed to women of child bearing
age. It utilises the principles of medicines optimisation, a paradigm
that aims to help patients get the best outcomes from using medicines.
However, this systematic review has some limitations. First, title and
abstract screening were only carried out by one researcher which means
that there is a possibility of missing publications. Second, for the
section on perceptions of teratogenic risk, the number of included
articles was relatively small, which is justified by the limited
publications in this area.