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.