Knowledge Transfer and Translation: Examining how Teratogen Information is Disseminated

ArticleinBirth Defects Research Part A Clinical and Molecular Teratology 91(11):956-61 · November 2011with11 Reads
DOI: 10.1002/bdra.22851 · Source: PubMed
Well-executed knowledge transfer and translation (KT) has become a vital part of effective health management. Following the thalidomide disaster, women and their health care providers became fearful of medications and environmental exposures that could affect the health of the unborn child. Therefore, it is important to disseminate evidenced-based information to pregnant women and their health care providers, enabling them to make empowered decisions regarding exposures during pregnancy. The objectives were twofold: (1) to explore the knowledge transfer process of teratology information from the research community to health care providers, pregnant women, and the general public; and (2) to examine how this impacts pregnant women and their health care providers who require this information. We searched the peer reviewed literature (PUBMED, MEDLINE, and EMBASE), retrieved and examined original studies and review articles, and identified relevant data to evaluate how KT is conducted in this field. We found that KT and teratology information is very complex, with confusing information, over-estimated fears of teratogenicity, as well as unhelpful, often negatively biased information from the media. Of all the methods we identified, Teratogen Information Services (TIS) appears to conduct the most effective KT approaches in this field. It is evident that KT in this area needs improvement. Women and their health care providers are highly impacted by the type of teratology information they receive, affecting for example, deciding to terminate a wanted pregnancy or discontinue a needed pharmacotherapy. When disseminating information in this very sensitive and complex field, it is imperative that good KT strategies are used, encompassing the availability and appropriate interpretation of information. It is most important that an evidence-based decision is made to ensure the optimal outcome for both the mother and her unborn child.
    • "This Danish online analogue to the Physicians' Desk Reference has since 2005 implemented a transparent and uniform algorithm , which provides the clinician with information on the level of scientific evidence; risk estimations and a clinical recommendation (see Additional file 3 for a translation of these principles). The difference in perception of the teratogenic potential for citalopram and sertraline between GP and OB/ GYN is noteworthy for several reasons: The issue of SSRIs during pregnancy has been subject to an extensive coverage within the health care community [21][22][23][24][25][26][27][28][29][30][31][32]. Numerous data are available and a recent comprehensive meta-analysis documented more than 56,000 exposed pregnancies [21]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Estimating the true risk of fetal malformations attributable to the use of medications is difficult and perception of risk by health professionals will impact their counseling and treatment of patients who need medication during pregnancy. The objective of this study was to assess the perception of the teratogenic risk of 9 commonly and 3 rarely prescribed drugs among general practitioners and specialists in obstetrics/gynecology. Methods All 811 general practitioners in the Region of Southern Denmark and all 502 specialist obstetricians/gynecologists in Denmark as a whole were invited to participate in the study based on an online questionnaire. Medians and interpercentile ranges of the perceived background risk and perceived risks for each of the drugs were included in the questionnaire. ResultsOne hundred forty three (18 %) general practitioners and 138 (27 %) obstetricians/gynecologists participated. Estimates provided by the participants were generally in accordance with current knowledge of drugs with established safety during pregnancy. Perceptions of risks associated with warfarin and retinoid exposure were severely underestimated. Conclusions Understanding of teratogenic background risk and specific risks associated with in utero exposure to 12 different drugs generally approached the established knowledge. The risk associated with warfarin and retinoid exposure was severely underestimated by both groups of health care professionals, while general practitioners specifically overestimated the risk of sertraline and citalopram to some extent. In Denmark, general practitioners can prescribe antidepressants, and even minor misconceptions of the teratogenic potential of citalopram and sertraline may be of clinical relevance. In Denmark, systemic retinoids can only be prescribed by a dermatologist, and warfarin treatment is only rarely initiated in women of the fertile age without involvement of specialists in internal medicine. Hence, the active knowledge on the teratogenic potential of these drugs is likely to be less accurate among general practitioners and obstetricians/gynecologists; although still of clinical importance since these specialists are largely involved in the counselling of pregnant women.
    Full-text · Article · Dec 2016
    • "Pregnant women living in developed countries frequently take prescription and over-the-counter (OTC) medications, with prevalence estimates ranging between 27% and 99%, depending on the medications examined and the data sources used (Mitchell et al., 2011; Daw et al., 2012; Friedman, 2012 ). Moreover, the number of women taking medications during pregnancy is growing as maternal age increases, and with the increasing use of medications in developed countries (Wysowski et al., 2006; Shahin and Einarson, 2011; Thorpe et al., 2013; Mazer-Amirshahi et al., 2014). Maternal exposure to medications during pregnancy is often unavoidable because they are used to treat chronic diseases or because the pregnancy was not yet recognized (Mitchell et al., 2011; Mazer-Amirshahi et al., 2014). "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Although there is strong evidence that some medications are teratogenic, the current lists of teratogens to be used in research are outdated. The objective of this study was to develop an updatable and systematic procedure to the classification of medications proven and potentially teratogenic in the first trimester of pregnancy, for use in research. Methods: We developed a two-step procedure for teratogen classification. Step 1 includes classifying the medications from Drugs in Pregnancy and Lactation: a Reference Guide to Fetal and Neonatal Risk (9th ed.) into two provisional lists: (1) teratogenic medications, and (2) potentially teratogenic medications. We also searched other references to add other medications. In Step 2, the Teratology Information System (TERIS) database was searched, and the medication was classified as teratogenic or potentially teratogenic according to a newly developed scheme. Expert consensus was used if a medication was not recorded in TERIS. Results: A total of 114 medications were identified in Drugs in Pregnancy and Lactation: a Reference Guide to Fetal and Neonatal Risk, with 57 medications in each provisional list. Seventy-eight medications were identified in other sources. A total of 135 medications were included in Step 2; the TERIS scheme classified 23 medications, and 112 medications required expert opinion. The two experts agreed on 78.6% of the medications (kappa = 0.63). We identified 91 teratogenic and 81 potentially teratogenic medications. Conclusion: Using reliable references, we established a systematic procedure to the classification of medications with evidence of or potential teratogenic risk. These exhaustive lists will be useful in teratology research and related fields. Birth Defects Research (Part A), 2016. © 2016 Wiley Periodicals, Inc.
    Full-text · Article · Mar 2016
    • "This suggests a clear risk of unnecessary use of medicines, misunderstandings, and groundless anxiety that could be avoided by the deployment of relevant, uniform, and accurate information. It has been argued that teratology information services (TIS) are effective in teratology information knowledge transfer by using evidence-based information expressed in lay language262728. These TIS exist all over North America, in Australia, and many European countries. "
    [Show abstract] [Hide abstract] ABSTRACT: A wide variety of information sources on medicines is available for pregnant women. When using multiple information sources, there is the risk that information will vary or even conflict. The objective of this multinational study was to analyze the extent to which pregnant women use multiple information sources and the consequences of conflicting information, and to investigate which maternal sociodemographic, lifestyle, and medical factors were associated with these objectives. An anonymous Internet-based questionnaire was made accessible during a period of 2 months, on 1 to 4 Internet websites used by pregnant women in 5 regions (Eastern Europe, Western Europe, Northern Europe, Americas, Australia). A total of 7092 responses were obtained (n=5090 pregnant women; n=2002 women with a child younger than 25 weeks). Descriptive statistics and logistic regression analysis were used. Of the respondents who stated that they needed information, 16.16% (655/4054) used one information source and 83.69% (3393/4054) used multiple information sources. Of respondents who used more than one information source, 22.62% (759/3355) stated that the information was conflicted. According to multivariate logistic regression analysis, factors significantly associated with experiencing conflict in medicine information included being a mother (OR 1.32, 95% CI 1.11-1.58), having university (OR 1.33, 95% CI 1.09-1.63) or other education (OR 1.49, 95% CI 1.09-2.03), residing in Eastern Europe (OR 1.52, 95% CI 1.22-1.89) or Australia (OR 2.28, 95% CI 1.42-3.67), use of 3 (OR 1.29, 95% CI 1.04-1.60) or >4 information sources (OR 1.82, 95% CI 1.49-2.23), and having ≥2 chronic diseases (OR 1.49, 95% CI 1.18-1.89). Because of conflicting information, 43.61% (331/759) decided not to use medication during pregnancy, 30.30% (230/759) sought a new information source, 32.67% (248/759) chose to rely on one source and ignore the conflicting one, 25.03% (190/759) became anxious, and 2.64% (20/759) did nothing. Factors significantly associated with not using medication as a consequence of conflicting information were being pregnant (OR 1.75, 95% CI 1.28-2.41) or experiencing 3-4 health disorders (OR 1.99, 95% CI 1.10-3.58). Women with no chronic diseases were more likely not to take medicines than women with ≥2 chronic diseases (OR 2.22, 95% CI 1.47-3.45). Factors significantly associated with becoming anxious were >4 information sources (OR 2.67, 95% CI 1.70-4.18) and residing in Eastern Europe (OR 0.57, 95% CI 0.36-0.90). Almost all the pregnant women used multiple information sources when seeking information on taking medicines during pregnancy and one-fifth obtained conflicting information, leading to anxiety and the decision not to use the medication. Regional, educational, and chronic disease characteristics were associated with experiencing conflicting information and influenced the decision not to use medication or increased anxiety. Accurate and uniform teratology information should be made more available to the public.
    Full-text · Article · Feb 2014
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