Providing Contraception for Women Taking Potentially Teratogenic Medications: A Survey of Internal Medicine Physicians’ Knowledge, Attitudes and Barriers
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The majority of women prescribed category D or X medications may not receive adequate contraceptive counseling or a reliable contraceptive method. Physicians who prescribe potentially teratogenic medications have a responsibility to provide women with contraceptive counseling, a method of highly-effective contraception, or both.
Investigate the knowledge, beliefs and barriers of primary care physicians toward providing adequate contraception to women taking potential teratogens.
DESIGN & PARTICIPANTS
Self-administered confidential survey of primary care internal medicine physicians at an urban, academic medical center.
Knowledge of potential teratogenic medications and contraceptive failure rates was assessed. Participants’ beliefs about adequacy of their medical education, practice limitations and attitudes toward improving provision of contraception to women on potential teratogens were assessed.
One hundred and ten physicians responded (57.3%). Nearly two-thirds (62.3%) of participants had cared for reproductive aged women taking category D or X medications in the past year. The mean percent of correctly identified category D or X medications was 58.4% (SD 22.1%). The mean percent correct for knowledge of published contraceptive failure rates was 64.6% (SD 23.1%). Most respondents (87.6%) felt it is the responsibility of primary care physicians to provide contraception. Time constraints were reported to be somewhat or very limiting by 61.3% and over half felt medical school (63.2%) or residency (58.1%) inadequately prepared them to prescribe or counsel about contraceptives.
Primary care physicians commonly encounter reproductive age women taking category D or X medications, but may lack sufficient knowledge and time to counsel about potential teratogens and contraception to prevent fetal exposure to these drugs.
KEY WORDSadult contraception counseling female humans physician practice patterns physician behavior pregnancy prescription drugs primary care survey teratogens women’s health
Funded by a grant supplied by a generous anonymous donor. This research was presented at the Fellowship in Family Planning National Conference in Chicago, May, 2009. We would like to thank the faculty and staff of the Research and Education for Academic Achievement (REACH) Network and the Northwestern University Clinical and Translational Sciences Institute (NUCATS) for their support during this project (grant UL1RR025741).
This research could not have been completed without the assistance of Charlie Zei and Jason Thompson, research assistant and programmer, respectively.
Conflicts of Interest
David Eisenberg has received honoraria and consulting fees from Bayer Schering Pharma and Haymarket Media. Catherine Stika has received a grant from Boehringer Ingelheim and has a grant pending from Biosante Pharma.
- 3.Cunningham GF, Leveno KL, Bloom SL, Hauth JC, Gilstrap LC, Williams KDW. Obstetrics, 22nd Edition. 22nd ed. New York: McGraw-Hill Professional; 2005:1600.Google Scholar
- 11.Verispan V. Top prescriptions dispensed in 2007.Google Scholar
- 12.Clinical Pharmacology. Gold Standard, Inc., Tampa, FL; 2009. www.jgim.org) was developed with experts in survey design and methodology. Specialists in the fields of contraception, pharmacology, teratology and primary care internal medicine assisted with the content and assessed the survey for face validity. It was then pretested among members of the internal medicine department at our institution, modified to reflect suggested changes from these reviewers, and then it was transferred to an electronic format using a web-based survey service http://www.clinicalpharmacology.com. Accessed November 20, 2009.
- 20.FDA. Pregnant Women to Benefit from Better Information. FDA Consumer Health Information [2008; http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM143746.pdf Accessed November 20, 2009.
- 23.Code of Federal Regulations, Title 21, Vol 4, 21 CFR201.57; 2001.Google Scholar
- 24.Physicians Desk Reference, 57th edition. Montvale, NJ: Thomson PDR; 2004.Google Scholar
- 25.Teratology public affairs committee position paper: pregnancy labeling for prescription drugs: ten years later. Birth Defects Res A Clin Mol Teratol. 2007;79(9):627–30.Google Scholar
- 28.Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussel J, Stewart F, et al., eds. Contraceptive Technology Eighteenth revised edition. New York: Ardent Media; 2004.Google Scholar