Oral retinoids, commonly prescribed for severe acne and sold under brand names such as Roaccutane, are highly effective treatments. However, their use during pregnancy can have devastating consequences, including miscarriages and severe congenital abnormalities. Despite warnings and guidelines, many women on these medications may not be using effective contraception.
Risks of Oral Retinoids During Pregnancy
Oral retinoids are known to cause significant harm to unborn babies if taken during pregnancy. The risks include:
Miscarriages: Increased likelihood of pregnancy loss.
Congenital Abnormalities: Major malformations in the brain, heart, and face. At least 30% of children exposed to oral retinoids in utero suffer from severe congenital abnormalities.
Neurodevelopmental Problems: Issues in learning, reading, social skills, memory, and attention.
Because of these risks, the Australasian College of Dermatologists strongly advises against prescribing oral retinoids to women who are pregnant or planning to become pregnant. Dermatologists are instructed to confirm that a woman is not pregnant before starting treatment and to thoroughly discuss the associated risks.
Current Contraception Practices
Despite these precautions, cases of pregnancies exposed to oral retinoids continue to be reported in Australia and globally. A recent study aimed to understand the extent of contraception use among Australian women of reproductive age who are taking oral retinoids.
Study Findings
The study, which analyzed data from Australia’s Pharmaceutical Benefit Scheme (PBS) between 2013 and 2021, revealed concerning trends:
Increase in Retinoid Use: The dispensing rate for oral retinoids doubled from one in every 71 women in 2013 to one in every 36 in 2021.
Lack of Concurrent Contraception: Only one in four women who were prescribed oral retinoids were also provided with contraception at the same time. This ratio was even lower among 15- to 19-year-olds, with only about one in eight being dispensed contraception.
These findings indicate a significant gap in ensuring that women using oral retinoids are also using effective contraception.
Contraception Options
Effective contraception is crucial for women on oral retinoids. Reliable methods include:
Long-Acting Reversible Contraceptives (LARCs): Intrauterine devices (IUDs) like Mirena, Kyleena, or copper devices, and implants such as Implanon, which are more than 99% effective.
Oral Contraceptive Pills: Highly effective among “perfect” users but less reliable in typical use.
Condoms: Less reliable with a failure rate that can be as high as 18% in typical use.
Recommendations for Improvement
To address the risks associated with oral retinoids and unintended pregnancies, a multi-faceted approach is necessary:
Education for Dermatologists: Enhance training for dermatologists on discussing contraception and sexual health with patients.
Education for Women: Increase awareness among women about the risks of oral retinoids and the importance of effective contraception.
Clinical Pathways: Establish clear clinical pathways to ensure women are prescribed both oral retinoids and effective contraception. This could involve GPs prescribing both or dermatologists ensuring a contraception plan is in place.
Improved Contraception Access: Address barriers to contraception access, particularly for teenagers and young women, by reducing costs, stigma, and improving knowledge.
Many women and doctors are already taking the right steps, but it is essential that every woman has an effective contraception plan before starting oral retinoids. This approach is crucial to preventing unintended pregnancies and reducing the risk of harm to unborn babies.
