Twenty-five years of counseling family physicians

Important considerations

We have learned that physicians caring for pregnant women sometimes hesitate to initiate or continue drug therapy because of medicolegal fears. An unfortunate example of this trend is the unwillingness to treat even moderate to severe depression, owing to mixed messages regarding the safety of antidepressants. We have counseled severely depressed women in crisis whose physicians refused to prescribe selective serotonin reuptake inhibitors, despite compelling evidence that the risks of untreated depression might be far more serious than the, thus far, unproven risks of the medications to fetuses.3

Another important area to be considered by family physicians is the use of folic acid for the prevention of neural tube defects. Despite folate fortification of flour products in Canada, 40% of Canadian women do not achieve protective systemic levels of folate to prevent neural tube defects.4 This led Motherisk, in collaboration with the Society of Obstetricians and Gynaecologists of Canada, to suggest 5 mg of folate daily to a larger group of women who might be at risk (Box 1).5

Nausea and vomiting of pregnancy is another condition for which we have spent much time conducting research and counseling women. Through our nausea and vomiting of pregnancy help line, we hope to make women’s day-to-day lives easier when coping with this sometimes debilitating condition of pregnancy, which is often ignored by caregivers in the medical community.6

Lastly, the most serious but preventable adverse teratogenic effect in pregnancy is the fetal alcohol spectrum disorder, affecting an estimated 1% of all Canadian children. Eradicating this avoidable tragedy must start with early identification of the problematic drinking mother and early screening to identify children at risk. Two initiatives by the Public Health Agency of Canada (in collaboration with Motherisk) to identify maternal drinking and screen children for fetal alcohol spectrum disorder have yielded new guidelines and tool kits, which will soon be distributed to all clinicians from coast to coast.

Conclusion

We thank the many family physicians across the country for their support and collaboration and for asking the right questions (approximately 4500 faxes with 15 000 questions), hundreds of which have been answered in Motherisk Update articles in Canadian Family Physician since 1995. The answers have and will continue to empower Canadian women and their physicians in making evidence-based decisions regarding the use of drugs and other exposures during pregnancy.

Keep the questions coming and we will continue to answer them ….