Preconceptional Care: Five Years Experience of a Teratology Information Service

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1 1st Central and Eastern European Summit on Preconception Health and Prevention of Birth Defects Budapest, Hungary, August 27-30, 2008 Preconceptional Care: Five Years Experience of a Teratology Information Service Marco De Santis, Elena Cesari Telefono Rosso- TIS Department of Obstetrics and Gynecology Catholic University- Rome

2 Teratology Information Services TISes focus on advising pregnant women, women planning pregnancy, breast feeding women and their families and health care providers on the reproductive safety or risk of prenatal exposure TISes interpret information regarding known and potential reproductive risks into risk assessments that are communicated to individuals of reproductive age and health care providers Hancock RL

3 Telefono Rosso Teratology Information Service Telefono Rosso is an ENTIS member Telefono Rosso answers 8000 calls per year TELEFONO ROSSO

4 Telefono Rosso Teratology Information Service It was founded at the Catholic University in It was conceived in order to give a skilled, simple and quick counselling by phone about: Exposure to drugs, chemicals or infectious agents during pregnancy and breastfeeding Preconceptional care

5 Telefono Rosso Teratology Information Service The information provided is based on current scientific data (TERIS, REPROTOX, TOXLINE, MEDLINE), which is collected and analyzed by TIS staff. All operators are gynecologists with expertise in teratology, prenatal diagnosis and fetal medicine It is open to health care providers and to general public It is free of charge and works from 9 a.m. to 1 p.m. for five days a week

6 Preconceptional counselling 7% 3% pregnancy preconceptional breastfeeding 90%

7 Study design Objective To evaluate the main reasons of awareness in preconceptional period, the prevalence of chronic maternal diseases and the attitude to acid folic supplementation in a population calling to an Italian Teratology Information Service. Method A descriptive study on 2405 callers asking for preconceptional care between 2002 and 2006.

8 Preconceptional counselling calls from 2002 to

9 Callers women 12% 7% physicians 81% relatives

10 Study population mean age 33+/-6.7 years 76% nulliparae 24% multiparae: 58% just one pregnancy before 42% more than one

11 Chronic diseases Preconceptional Care: Chronic disease referred at the moment of call 46% yes 54% no

12 Chronic diseases Preconceptional Care: 6% 6% 6% 1% 1% neurologic autoimmune 9% cardiovascular hormonal asthma and atopy diabetes 71% others

13 Reason for calling 2% 1% 1% 1% 1% 1% drugs radiations infections chemicals paternal drug exposure general informations Homeopatic and herbal medicine 94%

14 Reason for calling:paternal drug exposure 18% chemotherapy 20% 33% antivirals and interferon immunomodulators others 29%

15 Reason for calling: drugs ATC groups 5% 5% 4% 3% 3% 2% 1% neurologic antimicrobic NSAD and NS antireumathics respiratory 6% hormonal gastrointestinal and metamolism antiparasitic 8% 8% 46% cardiovascular genitourinary and sex hormon antineoplastic and immunomodulating dermatologicals 9% antithrombotics

16 Neurological drugs 11% 5% psycoanaleptic psycoleptic 29% antiepileptic 55% others

17 Psycoanaleptic drugs 11% SSRI 27% Tryciclic Antidepressant 62% Others

18 Psycoleptic drugs 20% Benzodiazepines 11% lithium 69% others

19 Antiepileptic drugs 8% 7% 1% carbamazepine 12% 30% valproic acid phenobarbital lamotrigine 18% gabapentin topiramate 24% levetiracetam

20 Teratogenic drugs 24% others 76% teratogenic drugs

21 Teratogenic drugs 7% 6% 3% 2% 1%1% SSRI antiepileptics retinoids anthyroids lithium 23% methotrexate 57% oral anticoagulants chemotherapy

22 Folic acid supplementation Assumption of folic acid at moment of call 46% yes 54% no

23 Folic acid supplementation Assumption of folic acid at the moment of call in epileptic women 12% yes 88% no

24 Conclusion Drug exposure is the main reason for calling Neurological compounds are the first drug group Twenty-four percent of drug are teratogenic Herbal and homeopatic products are under-represented, represented, despite the lack of information on their effects on the pregnancy

25 Conclusion Prevalence of chronic pathologies and teratogenic exposure are high and could enhance the risk of adverse pregnancy outcome Prevalence of preconceptional folic acid supplementation is still low, especially in high risk population, such as epileptic women

26 Conclusion Teratology Information Service supports preconceptional care Identifying teratogenicity of such exposure (i.e. lithium) Suggesting: -possible preconceptional shift of drug therapies (propylthiouracil( instead of methimazole), -the waiting period before pregnancy (i.e. retinoids) -to discontinue the treatment (i.e. epileptic therapy in selected women seizures free) or to fraction and lower the dosage Emphasizing the main preconceptional risk factors (smoke, obesity, alcohol, etc) Promoting vaccinations (rubella, varicella and B hepatitis) and folic acid supplementation

27 Conclusion Teratology Information Service preconceptionally counseled an high risk population,, thus it has the potential to prevent a great number of birth defects or other adverse pregnancy outcomes

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