title: Early pregnancy exposure to feto-toxic medications among out-patients in Malawi.
abstract: OBJECTIVE
  To estimate the proportion of women in early pregnancy prescribed potentially feto-toxic medications at an out-patient clinic in Malawi.
  
  
  METHODS
  Over six-months the number of women of child-bearing age attending out-patient clinics and prescribed medicines at Mitundu Community Hospital was derived from the hospital's registry and pharmacy records. Women prescribed potentially feto-toxic medicines (using Food and Drug Administration classifications) by medical assessments were subsequently interviewed and pregnancy tested. Exposure to potentially feto-toxic medications was estimated and differences between pregnant and non-pregnant women were described.
  
  
  RESULTS
  Of 8970 female outpatients, 1012 (11.3%; 95% CI: 10.6% to 12%) were prescribed potentially feto-toxic medicines. After excluding 740 as unlikely to be pregnant, 209 women had negative pregnancy tests and 63 were confirmed as pregnant, representing one in 16 of women prescribed contraindicated medicines or between 2.8% and 3.5% of all women attending in early pregnancy. Most medicines were FDA rated C or D. Only 152 (55.9%) of these women had been asked about pregnancy and prescribing practices did not discriminate between pregnant and non-pregnant patients.
  
  
  CONCLUSIONS
  Assessment and prescribing practices for women attending out-patient clinics who might be in early pregnancy were inadequate, increasing the risk of exposure to potentially feto-toxic medicines.
authors.affiliation: Kamuzu College of Nursing, University of Malawi , Lilongwe , Malawi .
authors.forename: Ezereth
authors.initials: E
authors.lastname: Kabuluzi
authors.forename: Malcolm
authors.initials: M
authors.lastname: Campbell
authors.forename: Linda
authors.initials: L
authors.lastname: McGowan
authors.forename: Ellen
authors.initials: E
authors.lastname: Chirwa
authors.forename: Loretta
authors.initials: L
authors.lastname: Brabin
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000453:epidemiology; D000328:Adult; D000075202:Contraindications; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D005315:Fetal Diseases / Q000139:chemically induced* / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D010045:Outpatients / Q000706:statistics & numerical data; D004364:Pharmaceutical Preparations / Q000145:classification; D011247:Pregnancy; D011258:Pregnancy Tests / Q000706:statistics & numerical data; D011261:Pregnancy Trimester, First; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology*; D013723:Teratogens; D055815:Young Adult
chemical_list: D004364:Pharmaceutical Preparations; D013723:Teratogens
keywords: Early pregnancy; Malawi; feto-toxic medicines; outpatients