If you have female adolescent patients with neurologic, hematologic-oncologic, or dermatologic concerns, it is certainly possible they are using a medication with a potential teratogenic side effect on the fetus if she becomes pregnant. Drugs such as topiramate, methotrexate, isotretinoin and others all fit in this category.
To avoid such a complication from occurring, contraception should be prescribed, but just how often do you or your colleagues in practice do this? Stancil et al. (10.1542/peds.2015-1352) conducted a retrospective review of adolescent visits over 5 years where a known teratogen for pregnancy risk was prescribed and used electronic health records to determine if contraceptives were actually ordered for a patient. . Sadly, less than 30% of the time they were. The authors further stratify by race and age to see if the rates of contraception prescription varied and they do. They also note the influence of a federal risk mitigation system for a particular teratogen, which also improves the prescription rate.
To further help us interpret the findings in this study, we have asked adolescent specialist Dr. Erica Gibson to share her opinion on the findings in a most interesting commentary (REF). Regardless of their being on a teratogenic agent, our female adolescent patients deserve our best efforts at sexual education and contraceptive counseling –and this study and commentary will reinforce those efforts. Take the time to read both the article and commentary and share the findings with both your primary care and subspecialty colleagues to make sure they are aware of how much better we can do in the area of adolescent contraceptive counseling.
