Documentation of contraception and pregnancy when prescribing potentially teratogenic medications for reproductive-age women

Ann Intern Med. 2007 Sep 18;147(6):370-6. doi: 10.7326/0003-4819-147-6-200709180-00006.


Background: Certain medications are identified by the U.S. Food and Drug Administration (FDA) as class D or X because they increase the risk for birth defects if used during pregnancy.

Objective: To assess pregnancy rates and the frequency of contraceptive counseling documented with prescriptions for class D or X drugs filled by women of reproductive age.

Design: Description of prescriptions filled in 2001.

Setting: A large health maintenance organization in northern California in 2001.

Patients: 488,175 women age 15 to 44 years who filled a total of 1,011,658 class A, B, D, or X prescriptions.

Measurements: Medications dispensed, contraceptive counseling, and pregnancy testing.

Results: A class D or X prescription was filled by 1 of every 6 women studied. Women who filled a prescription for class D or X medications were no more likely than women who filled prescriptions for safer, class A or B medications to have received contraceptive counseling, filled a contraceptive prescription, or been sterilized (48% vs. 51% of prescriptions). There was little variation by clinical indication in rates of contraceptive counseling with class D or X prescriptions, except for isotretinoin. Women who filled a class D or X prescription were only slightly less likely to have a pregnancy documented within 3 months than women filling a class A or B prescription (1.0% vs. 1.4% of prescriptions).

Limitations: International Classification of Diseases, Ninth Revision, codes underestimate contraceptive counseling. Documentation of a positive pregnancy test after filling a prescription may overestimate medication use in early pregnancy. Women who filled several prescriptions are overrepresented in prescription analyses.

Conclusion: Prescriptions for potentially teratogenic medications are frequently filled by women of childbearing age without documentation of contraceptive counseling.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • California
  • Contraception / statistics & numerical data*
  • Counseling / statistics & numerical data*
  • Documentation
  • Drug Prescriptions*
  • Female
  • Health Maintenance Organizations
  • Humans
  • Practice Patterns, Physicians'*
  • Pregnancy
  • Pregnancy Rate*
  • Retrospective Studies
  • Sterilization, Reproductive / statistics & numerical data
  • Teratogens*


  • Teratogens