title: Periconceptional folic acid and teratogenic drug use in women undergoing fertility treatments.
abstract: OBJECTIVE
  To evaluate periconception drug use in women undergoing fertility treatment and compare it to women with spontaneous pregnancies.
  
  
  METHODS
  Retrospective observational cohort study on reproductive-age women. Data on pregnancies, fertility treatments, prescription fillings and demographics were extracted from Clalit Health Services computerized systems. Two quality measures were evaluated: periconception folic acid prescription fillings and use of potentially hazardous drugs in early pregnancy.
  
  
  RESULTS
  There were 12,891 fertility treatment cycles in 4868 women; and 4968 women had spontaneous pregnancy. Periconceptional folic acid use was low and similar in both groups (31.3% of fertility cycles versus 29.9% of spontaneous pregnancies, p = 0.07). In the infertility group, 293 prescriptions for potentially hazardous drugs were filled within 45 days after the beginning of a fertility cycle (2.3% of cycles) compared to only 47 (0.9%) in women with spontaneous pregnancy (p < 0.001).
  
  
  CONCLUSIONS
  The periconception medical care of women who undergo fertility treatment is suboptimal and is not better than in women with spontaneous pregnancies. Folic acid use that can reduce the risk of congenital anomalies is underused; whereas the use of potentially hazardous drugs in early pregnancy is significant. More intensive and targeted counseling regarding drug use before pregnancy is urgently needed.
authors.affiliation: Departement of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel. shlomitri@gmail.com
authors.forename: Shlomit
authors.initials: S
authors.lastname: Riskin-Mashiah
authors.forename: Ron
authors.initials: R
authors.lastname: Auslender
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000517:prevention & control*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D006801:Humans; D007557:Israel; D008875:Middle Aged; D016742:Preconception Care / Q000592:standards*; D011247:Pregnancy; D011787:Quality of Health Care; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies; D013723:Teratogens; D014803:Vitamin B Complex / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D013723:Teratogens; D014803:Vitamin B Complex; D005492:Folic Acid