Bridging clinical toxicology and teratology: European survey of service integration

In the last decades there has been a growing interest in pregnant and breastfeeding patient's health and growing attention to the effects of drugs and chemicals during pregnancy and lactation. For this reason, many Teratology Information Services (TIS) have been established in Europe, providing information on known reproductive risks, conducting epidemiologic research and pharmacovigilance on drug-induced congenital malformations and cooperating within the European Network of Teratology Information Services (ENTIS). The Poison Control Centres (PCC) too may be contacted by patients for the use of drugs in pregnancy and lactation, and they can provide such advise with similar or lower confidence in comparison to the TIS.

The objective of this study is to identify among the PCC members of the European Association of Poison Centres and Clinical Toxicologists (EAPCCT) those that provide information or intend to provide better information on the use of drugs during pregnancy and lactation to the patients or to health professionals, with a perspective of expanding the collaboration between these two associations by offering training through webinars or other type of scientific information.

We invited the PCC in Europe to participate in a survey asking if and how they provide information about medicines during pregnancy and lactation. A second survey was carried out among the ENTIS members in order to assess the overall patients need for such type of advice.

Fifty-six PCC from 28 European countries received the invitation to participate in the survey. A total of 93% from 26 countries responded within 3 months after the first request. Sixty-two per cent of the PCC provide information on the use of drugs in pregnancy and lactation in the order of a 1,500-2,000 calls/year, while only 19% of the PCC include a TIS. Overall, 35% of the PCC were interested in expanding their knowledge in the teratology field. All 26 TIS from 16 countries participated in the survey: they provide information for more than 118,000 cases per year.

The collaboration between the PCC and TIS is potentially advantageous in order to share information and to provide a training to the clinical toxicologists in the field of clinical teratology in countries where there isn't a TIS, especially in the Eastern Europe where the TIS are almost absent. This will in turn provide a benefit to the health care professionals who may lack an evidence-based knowledge on medication safety in pregnancy.