Medications that can cause birth defects are collectively called teratogens, and new research shows that when young women are prescribed these drugs, they are often not counseled about the potential need for birth control to avoid a risky pregnancy.

In the new study, published in the journal Pediatrics, researchers looked at a group of girls and young women from ages 14 to 25 who visited a large Midwestern academic pediatric medical center between 2008–2012. The researchers wanted to find out how often the women were prescribed medications that carry known risks for birth defects if taken while pregnant. They didn’t look at whether providers spoke with the women about the teratogenic risk of the medication; rather, they wanted to know whether the young women who were prescribed these drugs had conversations with their providers about lowering their risk for getting pregnant, including counseling on choosing birth control or getting a prescription for contraception.

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Out of 4,172 clinic visits during the study period, the researchers found nearly 1,700 young women received 4,506 prescriptions for teratogenic medications. However, contraceptive counseling happened less than 30% of the time.

Overall, the medical specialities most likely to prescribe these medications to adolescents were neurology, hematology-oncology and dermatology. The drugs most commonly prescribed were topiramate (used for seizures and migraines), methotrexate (used for severe psoriasis, severe active rheumatoid arthritis and some cancers), diazepam (used for anxiety, muscle spasms, and seizures), isotretinoin (used for severe acne), and enalapril (used for high blood pressure and heart problems).

The researchers looked for documentation that the young women prescribed these drugs had a conversation with a clinician about the need for birth control, as well as whether they were prescribed a prescription or if they were referred to someone else for that conversation. The researchers found that the number of times such interactions were happening was “alarmingly low.” They argue that their findings, paired with prior research, together suggest that young women who are prescribed known teratogens are no more likely to get birth control counseling than women prescribed medications with a low or no birth defect risk.

Even when young women’s records indicated that they were counseled on birth defect risks associated with teratogens, few reported using contraceptives. Among the young women who were prescribed a teratogen but who were counseled on birth defect risks, the researchers report that only 11% received or were currently using some prescribed method of contraception. “It is safe to assume that this is a more systemic issue,” says study author Stephani Stancil, a nurse practitioner at Children’s Mercy Kansas City. “Our study raises awareness that this issue is mirrored in the adolescent population, and we hope to spur intervention to improve the reproductive health care in these vulnerable teens.”

The study has limitations, including the fact that determining whether these conversations happened relied on whether clinicians physically documented them in their electronic medical records. It is possible that physicians and the young women had conversations that were not recorded in the system.

A possible solution, says Stancil, is focusing on prevention. “One example would be normalizing conversations regarding the sexual health of adolescents, including risk reduction, as part of the health care visit,” she says.

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