• Bethany D Panchal, Rebecca Cash, Camille Moreno, Emily Vrontos, Cheryl Bourne, Sandra Palmer, Amy Simpson, and Ashish R Panchal.
• From Department of Family Medicine, The Ohio State University College of Medicine, Columbus, OH (BDP, EV, CB, SP, AS); Division of Epidemiology, The Ohio State University College of Public Health (RC, ARP); Department of OB/GYN and Specialized Women's Health, Cleveland Clinic Foundation, Cleveland, OH (CM); Department of Emergency Medicine, The Ohio State University College of Medicine (ARP). Bethany.panchal@osumc.edu.
• J Am Board Fam Med. 2019 Jul 1; 32 (4): 474-480.

IntroductionDuring pregnancy, women may be exposed to teratogenic medications resulting in a risk of complications and poor maternal-fetal outcomes. The objective of this study was to evaluate the prescription of teratogenic medications in women of childbearing age and the associated prescription of contraception in the primary care setting.MethodsThe use of high-risk, potentially teratogenic, medications was retrospectively evaluated in women of childbearing age (13 to 45 years old) at 2 family medicine practices. Charts were reviewed for medication use and whether patients received a form of birth control (medication, sterilization, or postmenopausal) with the teratogenic medications. A multivariable logistic regression model was used to estimate the age-adjusted association between receiving a teratogenic medication and contraception. A subgroup analysis excluding ondansetron was also performed.ResultsA total of 3,956 nonpregnant women were included with 988 (25%) prescribed at least 1 high-risk medication. The most commonly prescribed high-risk medications were ondansetron (n = 724, 73%) and lisinopril (n = 195, 20%). More than half (55%) of the women prescribed a high-risk medication were without a form of birth control. When ondansetron was excluded, 10% of the population was prescribed at least 1 high-risk medication with 62% also without a form of birth control. Women less than 25 years of age had decreased odds of receiving contraception when prescribed a teratogenic medication (adjusted odds ratio, 0.47; 95% confidence interval, 0.34-0.66).ConclusionIn a family medicine setting, 25% of women of childbearing age were prescribed a high-risk medication with over half not having evidence of contraception management. Interestingly, younger age women had lower odds of receiving contraceptive management when prescribed high-risk medications. Prescribers should be aware of and counsel on the risks of teratogenic medications and regularly evaluate reproductive plans for patients.© Copyright 2019 by the American Board of Family Medicine.

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