A novel clinic structure for exposure counseling during pregnancy

Abstract

Background Congenital malformations and adverse fetal outcomes secondary to teratogenic exposures are major public health concerns. We review all inquiries made to the Florida MotherToBaby service center as well as the novel Exposure Clinic, which offers direct patient counseling. Methods We completed a retrospective review of all inquiries made to the MotherToBaby Florida service and the Exposure Clinic consults between its inception January 2019 through December 2021. All de‐identified data was collected at the time of the inquiry and stored in the OTIS database. Aggregate data was then extracted and descriptive statistics were performed. A p value of less than .05 indicated statistical significance. Results In 2019, there were 163 total inquiries, 265 in 2020, and 1,279 in 2021. These 1,707 inquiries covered 2,809 unique exposures. In the Exposure Clinic, 49 patients were seen in 2019, 140 in 2020, and 263 in 2021. The clinic's geographical reach increased over time with patients from 22 different counties being seen in 2021. Of all individual exposures, 45% were evaluated in 452 unique encounters in the Exposure Clinic and 55% were evaluated in 1255 unique encounters via traditional modes of contact. The average number of exposures discussed at each clinic appointment 2.8 versus 1.2 in inquiries via traditional methods. The majority of all exposures were regarding prescription medications, specifically psychiatric medications, followed by immunizations. The exposure with the single most inquiries was the COVID‐19 vaccine. Conclusions This novel clinic structure allows for complex counseling and clinical recommendations regarding exposures during pregnancy.

Symptomatic COVID-19 in Pregnancy: Hospital Cohort Data between May 2020 and April 2021, Risk Factors and Medicolegal Implications

“…In addition, delivery planning should be adequately designed and implemented on a case-by-case basis by relying on a multidisciplinary, team-based approach that may include consultation with obstetric, maternal-fetal medicine, infectious disease, pulmonary-critical care, and pediatric specialists, whenever deemed necessary. Provable and documented compliance with recommendations and evidence-based criteria outlined and released by scientific societies and institutions (such as the Centers for Disease Control and Prevention [ 54 , 55 ], the American College of Obstetricians and Gynecologists [ 56 ], and the Society for Maternal-Fetal Medicine [ 57 ], among others) can greatly contribute to ensuring that care for pregnant patients with COVID-19 is delivered in a viable fashion, from a medicolegal perspective, in order to shield healthcare professionals from negligence-based malpractice allegations in case of adverse outcomes [ 58 , 59 , 60 ]. Novel telemedicine-based methods of providing care and counseling to pregnant women need to take into account the relevant norms and regulations [ 61 , 62 ], as well as the unique complexities that such innovative practices entail from a legal and ethical standpoint [ 63 , 64 ].…”

Impact of perinatal exposure counseling on patient reported emotional outcomes and decisional empowerment

“…Establishing more clinics like the USF Health Exposure Clinic-with genetic counselors and teratology-trained physicians-can extend the reach of services. These clinics offer medical management recommendations, decision-making support, psychosocial assistance, and interdisciplinary patient care (Pressman et al, 2022). Such initiatives have the potential to effectively bridge the gap in knowledge and improve patient outcomes.…”

“…In addition to telephone and online inquiries, MotherToBaby offers a face‐to‐face counseling service through their Florida affiliate, located at the University of South Florida. This is the only clinic currently dedicated to providing face‐to‐face exposure counseling with MotherToBaby teratogen information specialists (TIS) and a maternal fetal medicine physician trained in teratology and reproductive toxicology (Pressman et al, 2022).…”