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

Damase-Michel C, Pichereau J, Pathak A, Lacroix I, Montastruc JL. Perception of teratogenic and foetotoxic risk by health professionals: a survey in Midi-Pyrenees area. Pharmacy Practice 2008 Jan-Mar;6(1):15-19. Original Research 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 Louis MONTASTRUC. Received (first version): 21-Aug-2007 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 MidiPyrenees 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. * Christine DAMASE-MICHEL. PharmD PhD. Department of Pharmacology, Research Unit of Pharmacoepidemiology, Faculty of Medicine, University of Toulouse III Paul Sabatier, (France). Juliette PICHEREAU. PharmD. Department of Pharmacology, Research Unit of Pharmacoepidemiology, Faculty of Medicine, University of Toulouse III Paul Sabatier, (France). Atul PATHAK. MD PhD. Department of Pharmacology, Research Unit of Pharmacoepidemiology, Faculty of Medicine, University of Toulouse III Paul Sabatier, (France). Isabelle LACROIX. Pharm D. Department of Pharmacology, Research Unit of Pharmacoepidemiology, Faculty of Medicine, University of Toulouse III Paul Sabatier, (France). Jean Louis MONTASTRUC. MD PhD. Department of Pharmacology, Research Unit of Pharmacoepidemiology, Faculty of Medicine, University of Toulouse III Paul Sabatier, (France). Accepted: 22-Nov-2007 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. Keywords: Teratogens. Health Knowledge, Attitudes, Practice. France. PERCEPCIÓN DEL RIESGO TERATOGÉNICO Y FETOTÓXICO POR LOS PROFESIONALES DE LA SALUD: ESTUDIO EN EL AREA DE MIDI-PYRENEES RESUMEN Aconsejar o prescribir medicamentos durante el embarazo requiere que los profesionales de la salud evalúen la relación riesgo/beneficio para la mujer y su bebé. Una mala percepción del riesgo, puede llevar a decisiones inapropiadas para los resultados del embarazo. El objetivo del presente estudio fue evaluar la percepción del riesgo teratogénico y/o fetotóxico de medicamentos frecuentes por médicos generales (MG) y farmacéuticos comunitarios (FC) de la región de Midi-Pyrenees. Métodos: Se entrevistó a 103 MG y 104 FC. Se utilizó una escala visual analógica EVA para evaluar el riesgo de dar a luz un niño malformado si la madre había usado el medicamento durante el primer trimestre de embarazo. Para 9 medicamentos, los profesionales tenían que decir si pensaban que había un riesgo teratogéncio y/o fetotóxico cuando se administraban los medicamentos al final del embarazo. Resultados: el 97% y el 91% de los MG y FC respectivamente pensaron que la isotretinoína y la talidomida eran teratogénicos y más del 80% pensó que la amoxicilina y el paracetamol eran seguros al principio del embarazo. Sin embargo, el 19% de los MG y el 33 de los FC respondió que no había riesgo teratogénico en el valproato. Cerca del 11% tanto de MG y de FC dijo que la warfarina era segura durante el embarazo. Para el 22% de los MG y para 13% y 27% de FC el ibuprofeno y el enalaprilo eran seguros al final del embarazo, respectivamente. Para cada medicamento, el valor medio del riesgo teratogénico para los profesionales era superior a los valores encontrados en la literatura. Relativamente a la isotretinoína, talidomina y metoclopramida, el riesgo percibido era superior para los FC. www.pharmacypractice.org 15 Damase-Michel C, Pichereau J, Pathak A, Lacroix I, Montastruc JL. Perception of teratogenic and foetotoxic risk by health professionals: a survey in Midi-Pyrenees area. Pharmacy Practice 2008 Jan-Mar;6(1):15-19. Conclusión: Estos datos muestran que el posible riesgo teratogénico y fetotóxico de varios medicamentos frecuentemente utilizados no es conocido por los profesionales de la salud. Por el contrario, los MG y FC que piensan que existe riesgo, lo sobre-estiman. Esta mala interpretación puede conducir a decisiones inapropiadas en el embarazo. Palabras clave: Teratógenos. Conocimiento, actitudes y práctica sanitarias. Francia. INTRODUCTION After thalidomide had been marketed in the 1960s, people became aware of the teratogenic risk of drug used during pregnancy. Due to this event and several others (diethylstilbestrol in the 70s and retinoids in the 80s), drug prescription for a pregnant woman induces anxiety, not only for woman, but, also for health professionals. However, 1 drug prescription in pregnancy is common. Prescribing or counselling drugs during pregnancy requires health professionals to assess a benefit/risk ratio not only for woman herself but also for her baby. Thus, a right evaluation of the risk is essential. A lack of knowledge of teratogenic or foetotoxic properties of a drug may enhance the risk of neonatal malformation or disease. Conversely, if the risk of malformation is overestimated, this may lead to disadvantageous decisions for the woman and her intended infant. Moreover, previous studies from our group have found differences in the perception of risks according to drugs in a same 2 2,3 pharmacological class or to health professionals. The aim of the present study was to evaluate the knowledge of medication risk during pregnancy of general practitioners (GP) and community pharmacists (CP) of Midi-Pyrenees area. pregnancy. For each (...truncated)