Fewer than one-third of adolescent females prescribed a teratogenic medication were counseled about, prescribed, or referred for contraception, according to a retrospective review of data from a single academic pediatric medical center.
The records from 1,694 female patients aged 14-25 years, who received 4,506 medications of Food and Drug Administration pregnancy risk category D or X – mostly commonly topiramate, methotrexate, diazepam, isotretinoin, or enalapril – showed that contraceptive counseling, prescription, or referral occurred in 29% of visits, according to a paper published online Dec. 16 in Pediatrics.
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White females were 61% more likely to receive contraceptive provision than were nonwhites, and girls aged 16 years or older were 20% more likely to receive it than were girls aged 14-15 years (Pediatrics 2016, Jan. doi: 10.1542/peds.2015-1454).
Teratogens with a federal surveillance system, such as iPLEDGE or REMS, were associated with twofold increase in the rate of contraceptive provision, but a much lower likelihood of documentation of menstrual and sexual histories.
“This finding was unexpected given that the focus of these systems is to proactively reduce the risk of unplanned pregnancy during drug treatment,” wrote Stephani L. Stancil of Children’s Mercy Hospital, Kansas City, Mo., and coauthors.
“Opportunity exists in these adolescents to increase rates of contraceptive counsel, the prescription of contraception if appropriate, or referral for such care when it becomes necessary to use a medication with known teratogenic potential,” they said.
Children’s Mercy Hospital supported the study. No conflicts of interest were declared.