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  • Publication # 14-RA005

Changes are needed to improve primary care counseling about medication-induced birth defects

Primary Care

An estimated 1 in 6 women each year are given a prescription for a drug that can cause birth defects. Since half of all pregnancies are unplanned, it is important that physicians inform these women of these potential risks and encourage contraception. Birth defects are most likely to take place early in pregnancy before the woman is aware that she is pregnant. 

Clinical decision support (CDS) within the electronic medical record (EMR) should increase the likelihood that such women are counseled about these drug risks. However, a new study finds that even with CDS, 43 percent of women prescribed these medications do not receive any counseling about the potential for birth defects. 

The study examined practices at three suburban, community-based family practices and one urban, academic general internal medicine practice. The 41 physicians at these clinics received CDS that was developed to increase counseling about the risks of birth defects from certain medications. Alerts were triggered once per visit if a risky medication was prescribed. During the last 9 months of the study, these alerts were deactivated for half of the physicians participating in the study. A total of 10,029 female patients of reproductive age visited the study physicians. Of these, 19 percent agreed to participate in the study and completed surveys. After exclusions, 801 surveys were included in the study analysis. 

Among the women surveyed, 23 percent were prescribed drugs with the potential to cause birth defects by physicians receiving a CDS alert. Another 3 percent of women were prescribed such drugs when the physician was no longer receiving alerts. Some of the most commonly prescribed risky drugs were benzodiazepines, antimicrobials, and various blood pressure and cardiovascular medications. Women who received these medications tended to be older and less educated than women who received safer medications. 

Women more likely to report counseling were seeing a female physician. Those least likely to report counseling received an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blockers (medications used for blood pressure). Women who were pregnant or trying to conceive were not more likely to report counseling. 

However, women who did receive counseling were more likely to use contraception after being prescribed a medication considered risky than women who received no counseling. According to the researchers, more research is needed to improve CDS in this area and to develop other interventions that provide the proper information to these women. The study was supported in part by AHRQ (HS17093). 

See "Counseling about medication-induced birth defects with clinical decision support in primary care," by Eleanor Bimla Schwarz, M.D., M.S., Sara M. Parisi, M.S., M.P.H., Steven M. Handler, M.D., Ph.D., and others in the Journal of Women's Health 22(10), pp. 817-824, 2013.


Page last reviewed March 2014
Internet Citation: Changes are needed to improve primary care counseling about medication-induced birth defects: Primary Care. March 2014. Agency for Healthcare Research and Quality, Rockville, MD.


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