Use of psychotropic medications during pregnancy: perception of teratogenic risk among physicians in two Latin American countries

Cantilino, Amaury; Lorenzo, Laura; Paula, Juliane dos Anjos de; Einarson, Adrienne

doi:10.1590/1516-4446-2013-1221

Cited by 20 publications

(29 citation statements)

References 8 publications

(8 reference statements)

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“…Considerable uncertainty in prescribing AD and AX in pregnancy exists, even amongst clinicians with expertise in antenatal health care provision [2,9,11]. Women in general also express extreme reluctance to take medication in pregnancy [7,8,17].…”

Section: Appropriate Management Of Anxiety and Depression In Pregnancmentioning

confidence: 99%

“…Unclear messages contribute to pregnant women being reluctant to take psychotropic medication, including antidepressants and anxiolytics [5][6][7][8] with many fearing foetal harm.. Medical personnel including O&Gs and GPs form an important part of a pregnant woman's network of information sources during pregnancy and can impact patient decision-making around medications in pregnancy [7][8][9]. The Australian clinicians' own perception of teratogenicity of antidepressants (AD) and anxiolytics (AX) may influence counselling and care of vulnerable women and is largely unexplored.…”

Section: Introductionmentioning

confidence: 99%

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Prescribing antidepressants and anxiolytic medications to pregnant women: Comparing perception of risk of foetal teratogenicity between Australian Obstetricians and Gynaecologists, Speciality trainees and upskilled General Practitioners

Williams

Bruxner

Ballard

et al. 2020

Preprint

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Background: The decision of whether to prescribe antidepressants (AD) and anxiolytics (AX) to pregnant women is complex, with serious potential ramifications. Clinicians’ perception of the risk of teratogenicity significantly influences their prescribing decisions and in turn impacts maternal decision making. Our cross-sectional study sought to discern differences in perceived risk between Obstetricians and Gynaecologists (O&Gs) and General Practitioners (GPs) when prescribing these medications in pregnancy. Furthermore, we investigated factors impacting perception, clinicians’ willingness to prescribe and their approach to provision of patient information. Methods: This cross-sectional study was conducted via a nation-wide online SurveyMonkey extended to Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) database-derived affiliates: GP diplomates, fellows and trainees (5409 survey invitations: 545 respondents). O&Gs and GPs were compared using Pearson Chi-squared test for categorical variables and the Student t-test for continuous variables. Results: GPs reported higher rates of being aware of up-to-date medication prescription recommendations (57.6%) compared with O&Gs (44.2%). GPs also reported higher rates of training adequacy in psychotropic prescription (56.1% versus 29.0%). There was evidence to suggest GPs level of confidence in knowledge base, initiation and prescription of AD and AX was higher than those of O&Gs. The mean perception of patient non-compliance was similar between clinician groups (approximately 35%), but GPs perceived the extent of patient anxiety as higher compared to O&Gs (mean 73.7% (SD 21.3) versus 63.1% (SD 24.1), p<0.001). Both groups showed a strong preference for improved training rather than patient-focused technology (above 70% for both groups). Conclusion: Further development of clinician training in perinatal psychotropic prescription is warranted.

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Section: Appropriate Management Of Anxiety and Depression In Pregnancmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prescribing antidepressants and anxiolytic medications to pregnant women: Comparing perception of risk of foetal teratogenicity between Australian Obstetricians and Gynaecologists, Speciality trainees and upskilled General Practitioners

Williams

Bruxner

Ballard

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…7 Risk communication provided by the physician may also have a significant impact on the risk perception of the pregnant woman, and after receiving information about a possible teratogenic potential of a drug, it may be difficult for the woman to accept reassuring evidence-based drug information. 8 Toward realistic risk perception Drug information regarding pregnancy inherently conveys teratogenic risks. Consequently, if this information is presented in such a way that realistic risks are perceived, it may result in appropriate choices regarding drug use in pregnancy.…”

Section: Physicians' Risk Perceptionmentioning

confidence: 99%

“…[1][2][3][4] The erroneous perception of teratogenic risk is often shared by health care professionals. 2,[5][6][7][8] In this Clinical Opinion, we will focus on possible explanations and consequences related to this issue. We will also present some suggestions for risk communication that could result in a more rational clinical practice.…”

mentioning

confidence: 99%

Risk perception regarding drug use in pregnancy

Widnes

Schjøtt

2017

American Journal of Obstetrics and Gynecology

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Pregnant women, but also physicians, have unrealistically high perceptions of teratogenic drug effects. This may result in suboptimal treatment of disease and even influence decisions of whether to continue pregnancy. To attain more realistic teratogenic risk perceptions, several factors that influence this issue should be considered, and these are further discussed in this Clinical Opinion. Importantly, drug use may have several benefits, both for the pregnant woman's health and to avoid negative fetal effects of untreated maternal disease. A greater focus on this aspect may act to balance risk perceptions. Furthermore, both pregnant women and physicians need access to drug information sources that provide realistic risk estimates to increase confidence in appropriate drug use and prescribing. We suggest that access to decision support and individually tailored information provided by drug information centers may contribute to this goal.

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“…2 Although it is estimated that drug therapy is responsible for only 1% of all congenital defects of known etiology, 3 studies have demonstrated that the perception of teratogenic risk related to medications is overestimated by expectant mothers, women and healthcare providers. [4][5][6][7][8][9][10] In a survey conducted in 295 Dutch women, 5% stated that pregnant women should not use any drugs at all. 11 Erroneous risk perception may prevent the pregnant woman from using safe medications and influence compliance with pharmacological treatment.…”

Section: Introductionmentioning

confidence: 99%

Analysis of agreement between Visual Analogue Scales (VAS) and numerical questions to assess perception of teratogenic risks in treatment with drugs and radiotherapy in women

Pons

Guimarães

Knauth

et al. 2014

Rev. Bras. Saude Mater. Infant.

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Objectives: to evaluate the agreement between Visual Analogue Scales (VAS) and numerical questions as a way of assessing the perception of teratogenic risk of treatment with drugs and radiotherapy. Methods: the sample comprised 144 pregnant and 143 non-pregnant women consecutively recruited at public health centers in Porto Alegre, in the State of Rio Grande do Sul, from February to August 2011. The perception of risk for congenital malformations in the general population and the perceptions of teratogenic risk for exposure to acetaminophen, meto-clopramide, misoprostol and radiotherapy were measured using VAS and numerical questions. The agreement between the results of the two techniques was tested using a Bland-Altman plot. Results: the medians for the perceptions measured using VAS were higher than those obtained using numerical questions for all variables. The perception of risk for acetaminophen showed the lower bias of the two techniques (bias=13.17; p<0.001) and exposure to radiotherapy, the higher (bias=25.02; p<0.001). Conclusion: there was no agreement between the measurements obtained using the two techniques for any of the risk perceptions under study. Risk perceptions were higher using VAS, for all kinds of exposure. Studies should be conducted to assess whether there is overestimation in other situations and social contexts owing to the use of VAS.

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Use of psychotropic medications during pregnancy: perception of teratogenic risk among physicians in two Latin American countries

Cited by 20 publications

References 8 publications

Prescribing antidepressants and anxiolytic medications to pregnant women: Comparing perception of risk of foetal teratogenicity between Australian Obstetricians and Gynaecologists, Speciality trainees and upskilled General Practitioners

Prescribing antidepressants and anxiolytic medications to pregnant women: Comparing perception of risk of foetal teratogenicity between Australian Obstetricians and Gynaecologists, Speciality trainees and upskilled General Practitioners

Risk perception regarding drug use in pregnancy

Analysis of agreement between Visual Analogue Scales (VAS) and numerical questions to assess perception of teratogenic risks in treatment with drugs and radiotherapy in women

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