Physician Counseling
Counseling is a key concept in any patient encounter, particularly when
it comes to initiate new therapies during pregnancy as it helps
consolidate a patient-centered practice. In fact, informing patients
about the indication, dosage, regimen, side effect(s) and alternatives
can improve adherence and limit therapeutic failure, or help to
recognize adverse effects that otherwise might result in unnecessary
diagnostic tests and hospitalization [22]. It is imperative for
providers during the prenatal visit to obtain a thorough history about
medical problems and medications used to treat them, and to screen for
herbal medicine use in pregnancy which is particularly important as the
use of complementary and alternative medicine is high globally [23].
Some women might have stopped taking their medications prior to the
first visit with a provider after finding out they are pregnant. This
action can sometimes lead to deleterious consequences. For example,
women treated with SSRIs for depression who have discontinued the
medication of fear of fetal concern may have relapses and suicidal
ideation [24]. On the other hand, counseling may help prevent
unnecessary pregnancy termination because of perceived high fetal risk
not knowing the accurate extent of the risk in question due to lack of
proper information [25].
During the counseling, the provider must also distinguish between
teratogenicity which entails structural abnormalities to the fetus in
the first trimester and fetotoxicity referring to functional damage
later in pregnancy [26]. While the teratogenicity profile of some
drugs has been established through prior animal studies, detecting
fetotoxicity requires more research particularly as some effects
pertaining to neurodevelopment might not be evident until childhood.
Women prefer to seek information about medication use in pregnancy
directly from their healthcare providers. However, the challenge arises
when there is lack of evidence-based data to appropriately display a
risk-benefit assessment for the patient to decide [22, 27]. Database
such as LactMed®[28] and Reprotox®[29] are some of the common
resources utilized by clinicians when counseling patients, but these
databases can often give inconclusive recommendations given the paucity
of evidence available.