title: Underuse of pregnancy testing for women prescribed teratogenic medications in the emergency department.
abstract: OBJECTIVE
  The objectives were to estimate the frequency of pregnancy testing in emergency department (ED) visits by reproductive-aged women administered or prescribed teratogenic medications (Food and Drug Administration categories D or X) and to determine factors associated with nonreceipt of a pregnancy test.
  
  
  METHODS
  This was a retrospective cross-sectional study using 2005 through 2009 National Hospital Ambulatory Medical Care Survey data of ED visits by females ages 14 to 40 years. The number of visits was estimated where teratogenic medications were administered or prescribed and pregnancy testing was not conducted. The association of demographic and clinical factors with nonreceipt of pregnancy testing was assessed using multivariable logistic regression.
  
  
  RESULTS
  Of 39,859 sampled visits, representing an estimated 141.0 million ED visits by reproductive-aged females nationwide, 10.1 million (95% confidence interval [CI] = 8.9 to 11.3 million) estimated visits were associated with administration or prescription of teratogenic medications. Of these, 22.0% (95% CI = 19.8% to 24.2%) underwent pregnancy testing. The most frequent teratogenic medications administered without pregnancy testing were benzodiazepines (52.2%; 95% CI = 31.1% to 72.7%), antibiotics (10.7%; 95% CI = 5.0% to 16.3%), and antiepileptics (7.7%; 95% CI = 0.12% to 15.5%). The most common diagnoses associated with teratogenic drug prescription without pregnancy testing were psychiatric (16.1%; 95% CI = 13.6% to 18.6%), musculoskeletal (12.7%; 95% CI = 10.8% to 14.5%), and cardiac (9.5%; 95% CI = 7.6% to 11.3%). In multivariable analyses, visits by older (adjusted odds ratio [AOR] = 0.57, 95% CI = 0.42 to 0.79), non-Hispanic white females (AOR = 0.71; 95% CI = 0.54 to 0.93); visits in the Northeast region (AOR = 0.60; 95% CI = 0.42 to 0.86); and visits during which teratogenic medications were administered in the ED only (AOR = 0.74; 95% CI = 0.57 to 0.97) compared to prescribed at discharge only were less likely to have pregnancy testing.
  
  
  CONCLUSIONS
  A minority of ED visits by reproductive-aged women included pregnancy testing when patients were prescribed category D or X medications. Interventions are needed to ensure that pregnancy testing occurs before women are prescribed potentially teratogenic medications, as a preventable cause of infant morbidity.
authors: Division of Emergency Medicine, Children's National Medical Center, Washington, DC; Department of Pediatrics, George Washington University, Washington, DC; Department of Emergency Medicine, George Washington University, Washington, DC.
authors: Monika K
authors: MK
authors: Goyal
authors: Adam L
authors: AL
authors: Hersh
authors: Gia
authors: G
authors: Badolato
authors: Xianqun
authors: X
authors: Luan
authors: Maria
authors: M
authors: Trent
authors: Theoklis
authors: T
authors: Zaoutis
authors: James M
authors: JM
authors: Chamberlain
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D011247:Pregnancy; D011258:Pregnancy Tests / Q000706:statistics & numerical data*; D055553:Prescription Drugs; D012111:Residence Characteristics; D012189:Retrospective Studies; D013723:Teratogens; D014481:United States; D055815:Young Adult
chemical_list: D055553:Prescription Drugs; D013723:Teratogens
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