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).
J Am Board Fam Med. 2019 Jul-Aug;32(4):474-480. doi: 10.3122/jabfm.2019.04.180281.
During 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.
The 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.
A 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).
In 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.
在妊娠期间，女性可能会接触到致畸药物，从而导致并发症和母婴结局不佳的风险。本研究的目的是评估初级保健环境中生育年龄女性中致畸药物的处方情况以及相关避孕措施的应用。
回顾性评估了 2 家家庭医学诊所中生育年龄（13 至 45 岁）的女性使用高危、潜在致畸药物的情况。评估了药物使用情况以及患者是否在使用致畸药物时接受了某种避孕方式（药物、绝育或绝经后）。使用多变量逻辑回归模型估计接受致畸药物治疗与避孕之间的年龄调整关联。还进行了排除昂丹司琼的亚组分析。
共纳入 3956 名非孕妇，其中 988 名（25%）至少开具了 1 种高危药物。最常开具的高危药物是昂丹司琼（n=724，73%）和赖诺普利（n=195，20%）。超过一半（55%）开具高危药物的女性没有避孕措施。当排除昂丹司琼时，10%的人群至少开具了 1 种高危药物，其中 62%也没有避孕措施。当处方致畸药物时，年龄小于 25 岁的女性接受避孕措施的可能性降低（调整后的优势比，0.47；95%置信区间，0.34-0.66）。
在家庭医学环境中，25%的生育年龄女性开具了高危药物，其中超过一半的女性没有避孕管理的证据。有趣的是，年轻女性在开具高危药物时接受避孕管理的可能性较低。处方医生应该意识到并告知致畸药物的风险，并定期评估患者的生殖计划。
