Pregnancy and isotretinoin therapy

Abstract

A 29-year-old woman was given isotretinoin for severe, recalcitrant acne. During the first 3 months of treatment, she was taking an oral contraceptive agent that she had started at the same time as the isotretinoin. After deciding she wanted to become pregnant, the patient stopped taking the contraceptive agent but continued to take iso tretinoin for another 2 months.When the patient became pregnant, she sought advice from the Motherisk program regarding the fetal risks of exposure to iso tretinoin. With counselling, it became apparent that the patient had not understood the connection between isotretinoin and birth defects, and hence the need for continued effective contraception while taking the drug. After repeated counselling, the patient decided to terminate her pregnancy.

Pregnancy outcomes following first-trimester exposure to topical retinoids: a systematic review and meta-analysis

“…Oral retinoids have well‐established effectiveness in the treatment of acne, which is very common in women of reproductive age . However, they are potent teratogens and are suggested to cause a characteristic pattern of malformations in the central nervous system, the cranium, the face (most commonly the ear), the heart and the thymus .…”

“…The use of oral retinoids is contraindicated in pregnancy, and different pregnancy prevention programmes (e.g. Pregnancy Prevention Program, SMART, iPLEDGE) have been developed to restrict their inadvertent use during past years …”

Retinoid Embryopathy

“…The continued occurrence of fetal exposure to isotretinoin highlights the need for improved practices. These improvements will likely require intervention at multiple levels, including improved education for patients and healthcare providers, improved patient adherence with established safety protocols, and proper control of isotretinoin's distribution (Choi et al 2013). 8.…”

Medicines For Women

“…The US and Canadian guidelines for preventing fetal exposure to isotretinoin include the following: awareness of the risks, ruling out pregnancy at the beginning of treatment; parallel use of two forms of contraception during treatment, monitoring for pregnancy throughout treatment and avoiding pregnancy 1-3 months after the drug has been cleared from the body (Choi et al 2013;Pastuszak et al 1994). …”