Communicating risk
These are important concepts to consider in the context of the emerging threat of Zika virus and the news from the Centers for Disease Control and Prevention that it is a definitive cause of microcephaly and other severe fetal malformations. While there is a real risk for pregnant women, both through mosquitoes and sexual contact, women are likely to perceive the highest level of risk. In South America, where therapeutic abortion is often not an option, accurate risk communication is critical.
When medications are prescribed during pregnancy, the first step is determining that a drug is truly needed, often in consultation with a specialist. Once that determination is made, it’s key to ensure that women and their families are familiar with the known risk or the lack of risk based on the best available data. There are resources for physicians to help understand and communicate about drug risks in pregnancy, including information from the Organization of Teratology Information Specialists. It’s also important to note that in every pregnancy, there is a 1%-3% risk of major malformations, even if the drug itself is safe. And it can’t hurt to think defensively and document that conversation and that the patient appears to have understood the concept of risk.
Dr. Koren is professor of pharmacology and pharmacy at the University of Toronto. He is the founding director of the Motherisk Program. He reported having been a paid consultant for Novartis and for Duchesnay, which makes Diclegis to treat nausea and vomiting in pregnancy.