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Increasing contraceptive knowledge to promote safe use of isotretinoin

The JAMA Network Journals

An information sheet on contraceptives improved knowledge about their effectiveness among women visiting a dermatology practice, which could help promote safer use of the acne medicine isotretinoin which is linked to birth defects, according to an article published online by JAMA Dermatology.

Because isotretinoin is a known teratogen (medication or other substance that causes birth defects), the U.S. Food and Drug Administration regulates use in female patients of childbearing age through the iPledge program, which requires women to pledge to use two forms of contraception. Still, isotretinoin-exposed pregnancies continue to occur.

Carly A. Werner, M.D., of the University of Pittsburgh, and coauthors evaluated the effectiveness of an information sheet on women's contraceptive knowledge. Surveys to assess knowledge of the effectiveness of eight contraceptive methods were completed by 100 women visiting a single dermatology practice.

Prior to viewing the information sheet, more than half of the women (average age 27.5 years and 64 percent with at least a college education) overestimated the typical effectiveness of condoms, contraceptive injections and oral contraceptives. About 34 percent of the women had never heard of contraceptive implants and 16 percent had never heard of an intrauterine contraceptive device (IUD). Participants were able to correctly identify the typical effectiveness of an average of about half of the eight contraceptives they were asked about.

After reviewing the information sheet for an average of less than one minute (on average 31 seconds), the percentage of women able to correctly identify the typical effectiveness of contraceptives increased (subdermal implant, 45 percent to 78 percent; IUD, 61 percent to 83 percent; injection, 28 percent to 44 percent; ring, 60 percent to 69 percent; patch, 50 percent to 71 percent; pills, 41 percent to 65 percent; condoms, 25 percent to 45 percent; and withdrawal by the male partner, 74 percent to 90 percent). However, 55 percent of participants still overestimated the typical effectiveness of condoms.

"A contraceptive information sheet can significantly improve patients' contraceptive knowledge and may be a useful addition to efforts to prevent isotretinoin-induced birth defects," the study concludes.

Editorial: Promoting Safe Use of Isotretinoin

In a related editorial, Marie C. Leger, M.D., Ph.D., of New York University, writes: "To summarize, Werner and colleagues demonstrate that even a small investment in time on the part of physicians and patients can greatly enhance the understanding of contraception options. ... Closing this practice gap could both prevent pregnancies in patients receiving isotretinoin and help ensure that dermatologists do not inadvertently undertreat acne in women."

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JAMA Dermatology. Published online February 4, 2015. doi:10.1001/jamadermatol.2014.4171. Available pre-embargo to the media at http://media.jamanetwork.com.

Editor's Note: This study was funded in part by a U.S. Food and Drug Administration grant. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

To contact corresponding author Eleanor B. Schwarz, M.D., M.S., call Phyllis K. Brown at 916-734-9023 or email phyllis.brown@ucdmc.ucdavis.edu . To contact commentary author Marie C. Leger, M.D., Ph.D., call Jim Mandler at 212-404-3525 or email Jim.mandler@nyumc.org.

An author interview will be available when the embargo lifts on the JAMA Dermatology website: http://jama.md/18r5EDY

To place an electronic embedded link to this study in your story The link for this study will be live at the embargo time: http://archderm.jamanetwork.com/article.aspx?doi=10.1001/jamadermatol.2014.4171 and http://archderm.jamanetwork.com/article.aspx?doi=10.1001/jamadermatol.2014.4158.

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