Perception of teratogenic and foetotoxic risk by health professionals: a survey in Midi-Pyrenees area

  • Christine Damase-Michel
  • Juliette Pichereau
  • Atul Pathak
  • Isabelle Lacroix
  • Jean L. Montastruc
Keywords: Teratogens, Health Knowledge, Attitudes, Practice, France

Abstract

Counselling or prescribing drugs during pregnancy requires health professionals to assess risk/benefit ratio for women and their baby. A misperception of the risk may lead to inappropriate decisions for pregnancy outcomes.

The aim of the present study was to assess teratogenic and/or foetotoxic risk perception of common medications by general practitioners (GPs) and community pharmacists (CPs) from the Midi-Pyrenees area.

Methods: 103 GPs and 104 CPs were interviewed. For 21 given drugs, a visual-analogue scale was used to evaluate the risk to give birth to a malformed infant if the mother had taken the drug during first trimester of pregnancy. For 9 drugs, health professionals had to say if they thought there was a potential foetotoxic and/or neonatal risk when drugs were administered during late pregnancy.

Results: 97% and 91% of GPs and CPs respectively thought that isotretinoin and thalidomide are teratogenic and more than 80% thought that amoxicillin and acetaminophen are safe in early pregnancy. However, 19% of the GPs and 33% of CPs answered there were no teratogenic risk for valproate. Around 11% of both GPs and CPs said that warfarin was safe during pregnancy. For 22% of GPs and for 13% and 27% of CPs respectively, ibuprofen and enalapril were safe on late pregnancy. For each drug, mean value of perceived teratogenic risk by health professionals was higher than values that can be found in scientific references. Concerning isotretinoin, thalidomide and metoclopramide, perceived teratogenic risk was higher for CPs.

Conclusion: These data show that the potential teratogenic and foetotoxic risk of several commonly used drugs is unknown by health professionals. Conversely, GPs and CPs who think that a risk exists, overestimate it. This misperception can lead to inappropriate decisions for pregnancy outcomes.

Downloads

Download data is not yet available.

References

1. Lacroix I, Damase-Michel C, Lapeyre-Mestre M, Montastruc JL. Prescription of drugs during pregnancy in France. Lancet 2000;256:1735-6.

2. Montastruc JL, Bongard V, Lapeyre-Mestre M. Perception of the risk of gastrointestinal adverse drug reactions with non-steroidal anti-inflammatory drugs (including coxibs) : differences among general practitioners, gastroenterologists and rheumatologists. Eur J Clin Pharmacol. 2003;59:685-8.

3. Bongard V, Ménard-Taché S, Bagheri H, Kabiri K, Lapeyre-Mestre M, Montastruc JL. Perception of the risk of adverse drug reactions : differences between health professionals and non health professionals. Br J Clin Pharmacol. 2002;54:433-6.

4. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation: a reference guide for fetal and neonatal risk, 6th Edition, Lippincott Williams and Wilkins eds, Baltimore, 2002.

5. Reprotox: An information system on environmental hazards to human reproduction and development. The reproductive toxicology center, Bethesda, www.reprotox.org

6. Friedman JM, Polifka JE. Teris: The teratogenic information system. University of Washington, http:apps.medical.washington.edu/teris/

7. Damase-Michel C, Vié C, Lacroix I, Lapeyre-Mestre M, Montastruc JL. Drug counselling in pregnancy: an opinion survey of French community pharmacists. Pharmacoepidemiol Drug Saf. 2004;13:711-5.

8. Sanz E, Gomez-Lopez T, Martinez-Quintas MJ. Perception of teratogenic risk of common medicines. Eur J Obstet Gynecol Reprod Biol. 2001;95:127-31.

9. Bootman JL, Hurd PD, Gaines JA. Physician and pharmacist attitudes toward medication use. Am J Hosp Pharm. 1982; 39:818-21.

10. Pole M, Einarson A, Pairaudeau N, Einarson T, Koren G. Drug Labelling and risk perceptions of teratogenicity : A survey of pregnant canadian women and their health professionals. J Clin Pharmacol. 2000;40:573-7.

11. Koren G, Bologa M, Long D, Feldman Y, Shear NH. Perception of teratogenic risk by pregnant women exposed to drugs and chemicals during the first trimester. Am J Obstet Gynecol. 1989;160:1190-4.

12. Koren G, Bologa M, Pastuszak A. Women’s perception of teratogenic risk. Can J Public Health 1991;82:S11-4.

13. Mazzota P, Magee LA, Maltepe C, Lifshitz A, Navioz Y, Koren G. The perception of teratogenic risk by women with nausea and vomiting of pregnancy. Reprod Toxicol. 1999;13:313-9.

14. Jasper JD, Goel R, Einarson A, Gallo M, Koren G. Effects of framing on teratogenic risk perception in pregnant women. Lancet 2001;358:1237-8.

15. Polifka JE, Faustman EM, Neil N. Weighing the risks and the benefits : a call for the empirical assessment of perceived teratogenic risk. Reprod Toxicol. 1997;11:633-40.

16. Aronson JK. Risk perception in drug therapy : Editors’view. Br J Clin Pharmacol. 2006;62:135-7.
Published
2008-03-10
Section
Original Research