Trends and predictors of women's risk perception about medications that may cause birth defects
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The purpose of this study was to evaluate the proportion of women who reported perception of medications as a risk for birth defects, whether perceptions have changed over time, and identify socioeconomic and medical factors that are independent predictors of perception of medication risk. The information gained may be useful in developing strategies for the risk management of known teratogens and enhancing the appropriate use of medications known to be safe. From 1976 to 2015, 51,413 women from the Slone Epidemiology Center Birth Defect Study (Slone BDS) were interviewed about whether they were aware of any medication or other substance that might cause birth defects, and about sociodemographic and medical factors. This analysis focused on those participants who reported one or more medication (or vitamin) as a risk factor for birth defects. The results demonstrated a general trend towards fewer women perceiving medication risk over the past four decades. The proportions of women who reported perception were higher for the following variables: older maternal age, white race, higher educational levels, previous pregnancy of a child with reported birth defects, daily medication use during pregnancy, wanted pregnancy, and alcohol use during pregnancy. The study does not support the likelihood of recall bias in women who gave birth to a baby with a birth defect, an important concern in epidemiological studies of birth defects. Misconception of risk was identified; of the top ten medications reported as potentially teratogenic, only three (thalidomide, isotretinoin, and diethylstilbestrol) are established teratogens. Overestimation of risk could potentially impact a woman’s decision to continue a pregnancy or cause unnecessary anxiety when using a medication that is needed during pregnancy. It has previously been shown that counseling pregnant woman can decrease the misperception of teratogenic risk from medications used for nausea and vomiting of pregnancy. Other researchers have suggested that greater use of drug information centers, such as the Norwegian network of drug information centers (RELIS), may help guide pregnant women and prescribing providers to improve teratogenic risk management.