Threats to Evidence-Based Care With Teratogenic Medications in States With Abortion Restrictions

Patients who unintentionally became pregnant while taking a teratogenic drug could choose to have an abortion before late June. However, on October 7, 13 states banned all abortions (including unintentional pregnancy while taking teratogenic medications) with few exceptions.

Numerous patients (who could become pregnant) receive teratogenic drugs for various life-threatening conditions. Medical specialists such as dermatologists, rheumatologists, and neurologists frequently prescribe teratogenic drugs but do not perform abortions. Thus state bans on abortions could influence the medications they prescribe, which may harm the patients and their offspring because those women will have no alternative option if/when contraception fails.

This abortion ban decision might also direct physicians to possibly restrict the use of effective medications that are standard care for other patient groups because of potential concerns about causing fetal harm. On the contrary, evidence about teratogenicity is lacking for many medications used in neurology. So many medications often prescribed in neurology already have minimal information about their safety profiles. 

Physicians think this ban decision comes with a great need for very frank conversations about sex and contraception with patients considering or already taking teratogenic drugs. However, achieving contraception while taking the essential teratogenic medication may be difficult in some situations, like in patients with a significant intellectual disability (who experience higher rates of sexual violence than the general population). 

Thus, not prescribing a teratogenic drug that is the standard of care because the patient could become pregnant and not be able to have an abortion is arguably unethical.

Source: JAMA. Published online October 12, 2022. doi:10.1001/jama.2022.11489

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