Fetal exposure to isotretinoin-an international problem.
BACKGROUND
Isotretinoin is a known teratogen. Pregnancy prevention programs aimed at minimizing isotretinoin exposure in pregnancy have been implemented in North America with limited success.


OBJECTIVE
To compare the management of fetal risk of isotretinoin in three countries, including information given to women, implementation of contraceptive methods, and pregnancy outcomes.


METHODS
Pregnant women exposed to isotretinoin who called teratogen information services (TIS) in Israel, Italy and Canada between July 1998 and October 2006 were interviewed at the time of initial consultation and after the expected day of delivery.


RESULTS
Fifty-three pregnant women exposed to isotretinoin contacted the TIS. Only 41% reported using a birth control method. Just one patient reported using two different forms. Forty-five percent of exposed pregnancies were terminated before delivery and 22% delivered healthy babies. Two babies were born with malformations.


CONCLUSIONS
Since isotretinoin-exposed pregnancies still occur, there is a need for more effective strategies, which should take into account the cultural differences.
Garcia-Bournissen
Facundo
F
Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Canada.
Tsur
Lilach
L
Goldstein
Lee H
LH
Staroselsky
Arthur
A
Avner
Marina
M
Asrar
Farhan
F
Berkovitch
Matitiahu
M
Straface
Gianluca
G
Koren
Gideon
G
De Santis
Marco
M
D000014:Abnormalities, Drug-Induced / Q000209:etiology* / Q000517:prevention & control; D000032:Abortion, Therapeutic; D000328:Adult; D002170:Canada; D003267:Contraception; D003879:Dermatologic Agents / Q000633:toxicity*; D004346:Drug Information Services; D005260:Female; D005333:Fetus / Q000187:drug effects*; D005500:Follow-Up Studies; D014943:Global Health; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D015474:Isotretinoin / Q000633:toxicity*; D007557:Israel; D007558:Italy; D050498:Live Birth; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011795:Surveys and Questionnaires; D013723:Teratogens
D003879:Dermatologic Agents; D013723:Teratogens; D015474:Isotretinoin