title: Terminations of pregnancy associated with isotretinoin use in New Zealand.
abstract: OBJECTIVE
  Oral isotretinoin is a highly-effective treatment for severe acne. It is also highly teratogenic. Recently, funded access was widened (from vocationally registered dermatologists only) to include vocationally trained general practitioners and nurse practitioners acting within their scope of practice. This decision has caused some debate. While it is hoped that it will increase access to those living in more deprived areas, there are concerns that there will be an increase in the number of affected pregnancies. This study aims to report on terminations of pregnancy occurring while using isotretinoin in New Zealand.
  
  
  METHODS
  Using NHI numbers, termination of pregnancy admissions were matched to recent isotretinoin prescriptions.
  
  
  RESULTS
  This study has revealed that there appears to have been more unintended pregnancies related to isotretinoin use than previously thought. A total of 39 terminations of pregnancy related to isotretinoin use were identified in the year ending June 2008. This gave a crude termination of pregnancy rate of 73 per 10,000 females aged 10-44 years.
  
  
  CONCLUSIONS
  While there are some limitations to this study, the results are consistent with recent international research suggesting previous pregnancy rates on isotretinoin have been underestimates. Widening funding of isotretinoin will likely increase the absolute numbers of pregnancies but also has the potential to increase relative numbers. As such, it will be vital that primary care is alert to the risks of isotretinoin use and gain experience in its day-to-day usage. Although access has been widened, all requests for funding will now be recorded on a national database (Special Authority database) to enable closer monitoring of isotretinoin usage.
authors.affiliation: PHARMAC, PO Box 10-254, Wellington 6011, New Zealand. peter.moodie@pharmac.govt.nz
authors.forename: Peter
authors.initials: P
authors.lastname: Moodie
authors.forename: Richard
authors.initials: R
authors.lastname: Jaine
authors.forename: Jason
authors.initials: J
authors.lastname: Arnold
authors.forename: Scott
authors.initials: S
authors.lastname: Metcalfe
authors.forename: Mike
authors.initials: M
authors.lastname: Bignall
authors.forename: Bruce
authors.initials: B
authors.lastname: Arroll
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000453:epidemiology; D000028:Abortion, Induced / Q000706:statistics & numerical data*; D000152:Acne Vulgaris / Q000188:drug therapy*; D000293:Adolescent; D000328:Adult; D002648:Child; D003879:Dermatologic Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015474:Isotretinoin / Q000009:adverse effects*; D009520:New Zealand / Q000453:epidemiology; D011247:Pregnancy
chemical_list: D003879:Dermatologic Agents; D015474:Isotretinoin