Teratogens Are Often Prescribed Without Pregnancy Testing

Ali S. Raja, MD, MBA, MPH, FACEP reviewing Goyal MK et al. Acad Emerg Med 2015 Jan 29.

Only 22% of reproductive-aged female patients had pregnancy tests performed before being prescribed potentially teratogenic medications.

Given the unreliability of sexual histories and the unplanned nature of emergency department (ED) visits, pregnancy testing is often the only valid method for determining whether female patients of childbearing age are pregnant. This determination becomes especially important when treating these patients with medications with the potential for teratogenicity — those categorized as D or X by the U.S. Food and Drug Administration. Researchers analyzed National Hospital Ambulatory Medical Care Survey data from 2005 to 2009 to determine how often female patients aged 14 to 40 were prescribed teratogens without pregnancy testing.

Among an estimated 141 million ED visits by reproductive-aged female patients, 10 million were associated with administration or prescription of teratogens, and of these, only 22% included pregnancy testing. The most frequent medications prescribed without testing were benzodiazepines, antibiotics, and antiepileptics.

Citation(s):

Goyal MK et al. Underuse of pregnancy testing for women prescribed teratogenic medications in the emergency department. Acad Emerg Med 2015 Jan 29; [e-pub ahead of print].