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GPs hand out risky scripts after pregnancy is recorded

GPs are prescribing potentially teratogenic medications to some women even after pregnancy has been confirmed, a new study reveals.

The research has prompted calls for GPs to conduct thorough medication reviews with all women as soon as they are aware of pregnancy, writes Cato Pedder.

Researchers found that in the 90 days before pregnancy was recorded (period I), 7 per cent of mothers in the UK received high-risk medicines classed by the US Food and Drug Administration as 'category X'.

Even in the following 70 days (period II) at least 0.6 per cent and possibly as many as 0.8 per cent continued to be given category X drugs (see box, below).

Study leader Dr Janet Hardy, a researcher in the division of preventive and behavioural medicine at the University of Massachusetts, US, said: 'Category X medications, by definition, involve risk to the fetus that outweighs possible benefit.

'It is challenging to consider the purpose of prescribing medications such as contraceptives once pregnancy has been documented in the medical record.'

Dr Hardy added: 'The visit when pregnancy is first medically recognised represents an opportunity to review prescribed medications in light of contraindication or fetal risk.'

Published online by Pharmacoepidemiology and Drug Safety, the study examined prescribing before pregnancy and during early stages in 81,975 mothers identified through the UK general practice research database.

Of the category X medications prescribed in period II, progesterone accounted for 46 per cent, contraceptives 17 per cent, hypnotic-anxiolytics 14 per cent and anti-helminthic drugs 9 per cent.

Professor Saad Shakir, director of the Drug Safety Research Unit in Southampton and a part- time GP, said pregnant women were continuing to take drugs because they had not been told to stop. 'GPs should do more. When a woman gets pregnant you need to ensure she's not taking anything detrimental.'

But Dr Peter Fellows, chair of the GPC prescribing subcommittee, questioned whether reviews were necessary. 'I don't think there's much wrong with the system as it is,' he said.

Category X scripts in pregnancy

During 90 days before RECORD OF pregnancy Proportion

of total (%)

Contraceptive 64

Hypothalamic and pituitary 17

Progesterone 8

Other endocrine 5

During 70 days after record of pregnancy

Progesterone 46

Contraceptive 17

Hypnotic-anxiolytic 14

Anti-helminthic 9

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