title: Contraceptive Provision to Adolescent Females Prescribed Teratogenic Medications.
abstract: OBJECTIVE
  Rates of adult women receiving contraceptive provision when simultaneously prescribed a known teratogen are alarmingly low. The prevalence of this behavior among pediatric providers and their adolescent patients is unknown. The objective of this study was to describe pediatric provider behaviors for prescribing teratogens concurrently with counseling, referral, and/or prescribing of contraception (collectively called contraceptive provision) in the adolescent population.
  
  
  METHODS
  A retrospective review was conducted examining visits in 2008-2012 by adolescents aged 14 to 25 years in which a known teratogen (US Food and Drug Administration pregnancy risk category D or X) was prescribed. The electronic medical records were queried for demographic information, evidence of contraceptive provision, and menstrual and sexual histories. The data were analyzed using standard statistical methods.
  
  
  RESULTS
  Within 4172 clinic visits, 1694 females received 4506 prescriptions for teratogenic medications. The most commonly prescribed teratogens were topiramate, methotrexate, diazepam, isotretinoin, and enalapril. The subspecialties prescribing teratogens most frequently were neurology, hematology-oncology, and dermatology. Overall, contraceptive provision was documented in 28.6% of the visits. Whites versus nonwhites and older versus younger girls were more likely to receive contraceptive provision. The presence of a federal risk mitigation system for the teratogen also increased the likelihood of contraceptive provision.
  
  
  CONCLUSIONS
  Our data demonstrate female adolescents prescribed teratogens receive inadequate contraception provision, which could increase their risk for negative pregnancy outcomes. Although the presence of a federal risk mitigation system appears to improve contraceptive provision, these systems are costly and, in some instances, difficult to implement. Efforts to improve provider practices are needed.
authors.affiliation: Divisions of Adolescent Medicine, Division of Pharmacology and Toxicology, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri; slstancil@cmh.edu.
authors.forename: Stephani L
authors.initials: SL
authors.lastname: Stancil
authors.affiliation: Emergency Medicine, and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri;
authors.forename: Melissa
authors.initials: M
authors.lastname: Miller
authors.affiliation: Kansas City University of Medicine and Biosciences, Kansas City, Missouri;
authors.forename: Holley
authors.initials: H
authors.lastname: Briggs
authors.affiliation: Divisions of Adolescent Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri;
authors.forename: Daryl
authors.initials: D
authors.lastname: Lynch
authors.affiliation: University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri; University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri;
authors.forename: Kathy
authors.initials: K
authors.lastname: Goggin
authors.affiliation: Division of Pharmacology and Toxicology, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri; Arkansas Children's Hospital Research Institute, Little Rock, Arkansas; and Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Gregory
authors.initials: G
authors.lastname: Kearns
mesh_terms: D000014:Abnormalities, Drug-Induced; D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000706:statistics & numerical data*; D003270:Contraceptive Agents / Q000008:administration & dosage*; D003376:Counseling / Q000706:statistics & numerical data*; D011307:Drug Prescriptions; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D013723:Teratogens; D014481:United States; D055815:Young Adult
chemical_list: D003270:Contraceptive Agents; D013723:Teratogens