Flagging the risk of birth defects
DOCTORS are often failing to inform patients about the risk of birth defects to their potential unborn babies from a commonly used drug to treat epilepsy, according to a literature review by a University of Manchester researcher in the United Kingdom.
The study by PhD student Wejdan Shroukh also reveals that both clinical staff and patients can dangerously misjudge the risk of taking a group of drugs called teratogenic medicines, which are associated with birth defects.
Her review, published in the Journal of Birth Defects, examined 55 papers that assessed the frequency of advice on contraception and pregnancy testing given to women taking teratogenic medicines by doctors in the United
States and UK.
Seven of the papers investigated sodium valproate use in the UK – a common prescription drug for epilepsy and psychiatric disorders, as well as migraine.
Of patients taking the drug, a large variable of 17% to 70% received contraceptive counselling, a quarter had pregnancy testing during treatment and 18-33% used contraception during treatment.
Sodium valproate is prescribed to about 24% of women aged 50 or younger.
It is associated with a high risk of spina bifida, heart defects and cleft palate, as well as malformations of the kidneys, urinary tract and cardiovascular system in newborns.
Shroukh also reviewed seven other studies that evaluated if health professionals and patients were able to correctly estimate the risk of different teratogenic medicines.
In the studies, doctors and community pharmacists, among others, usually overestimated the risks associated with a number of teratogenic drugs, including the blood thinner warfarin, sodium valproate and the acne drug isotretinoin.
She says: “Any baby born with malformations is a tragedy, but if that happens as a result of taking teratogenic medicines without full knowledge of the risks, then that is surely an avoidable tragedy.
“It’s clear from this review that many younger women are not receiving the advice they need if they are to make fully informed choices about these drugs.
“It is widely accepted that drug information leaflets are not enough when the risks are quite high.
“But it is essential that patients continue to take their medication and should speak to their GP (general practitioner) if they have any concerns.”
The pharmacy researcher adds: “This is not about blaming busy doctors and clinicians.
“It’s about awareness-raising and ensuring best practice is followed whenever possible.
“Health professionals need to ensure their patients understand risks and that means providing patient-centred healthcare.
“Healthcare needs to be respectful of, and responsive to, patient preferences, needs and values.
“The patient’s needs and values must guide clinical decisionmaking.”