Teratogen use in women of childbearing potential: an intervention study

The purpose of this study was to quantify the number of women of childbearing potential who are prescribed angiotensin-converting enzyme inhibitor (ACE inhibitor), angiotensin receptor blocker (ARB), or HMG-coenzyme A reductase inhibitor (statin) and to determine the number of documented teratogenic risk discussions (risk documentation) before and after educational interventions.

The institutional review board-approved retrospective chart review included female patients ages 15 to 45 years who were prescribed an ACE inhibitor, ARB, or statin between January 1, 2007, and March 1, 2009. Exclusion criteria were tubal ligation and hysterectomy. A survey determined physician knowledge of teratogenic risks and prescribing practices for targeted medications. Educational interventions were implemented. Data was reviewed and analyzed quarterly for 1 year.

Baseline analysis included 200 patients. A total of 129 (64.5%) patients were prescribed an ACE inhibitor, 29 (14.5%) were prescribed an ARB, and 88 (44.0%) were prescribed a statin. Risk documentation occurred for 40 (20%) patients. Analysis after intervention of 131 patients revealed that risk documentation was 2.4 times greater than before intervention (odds ratio, 2.4; 95% CI, 1.5-3.9). No significant difference identified in survey responses before and after intervention; however, resident physicians overestimated risk documentation.

Physicians' baseline awareness of ACE inhibitor, ARB, or statin teratogenic risks and risk documentation was lacking. Improvement in risk documentation was seen after intervention; however, continual improvement is essential.