Study: Contraceptives should be given with retinoids to protect the fetus

Prescription oral retinoids for acne are growing in popularity. Unfortunately, evidence shows that not enough precautions are being taken to protect women from the risk of serious birth defects if they become pregnant while taking this medication.

Demand for oral retinoids to treat acne has nearly doubled over the past nine years, but study finds that contraception not given due consideration for women of reproductive age taking these drugs.

Oral retinoids such as isotretinoin, if taken during pregnancy, can cause miscarriages, serious birth defects, and neurodevelopmental problems in the baby. These serious problems are not seen with retinoids applied to the skin.

Researchers are concerned about the increase in retinoid use and the lack of contraception coverage, with only 1 in 4 women taking both drugs.

"Every woman should have an effective contraceptive plan well before starting oral retinoids. Only then can we reduce the number of unintended pregnancies among women taking oral retinoids, and therefore reduce the risk of harm to unborn children," says Sr. Author Dr Antonia Shand from the University of Sydney.

"This is definitely a problem. I've seen a lot of women get pregnant while taking oral retinoids and then have to deal with the consequences," said lead author and maternal-fetal medicine specialist Dr. Laura Gerhardi.

The results, published in the Australasian Journal of Dermatology examined data from Australia's Pharmaceutical Benefit Scheme program between 2013 and 2021 for a sample of Australian women aged 15 to 44 years old.

Researchers from the University of Sydney and the University of New South Wales analyzed the frequency of oral retinoid prescriptions and how many of them were accompanied by contraceptive prescriptions.

Over nine years, there were 1,545,800 prescriptions for retinoids for women of reproductive age, and 57% of these were for oral retinoids in Australia. The rest took retinoids for external use.

Prescription rates for oral retinoids have doubled from 1 in 71 women in 2013 to 1 in 35 women in 2021. However, only 25% of these oral retinoid prescriptions in 2021 were accompanied by evidence of contraceptive use.

Leading dermatology, obstetrics, and pharmaceutical regulatory organizations recommend avoiding pregnancy while using oral retinoids and for some period after treatment.

However, in Australia there is currently no standardized pregnancy prevention program for women taking oral retinoids. By comparison, the United States requires women to take two types of contraception when using oral retinoids.

Researchers are calling for improved education for doctors and a clear pathway for women of reproductive age to safely obtain both retinoids and long-term reversible contraception.

They also emphasize the importance of education for women. This includes developing an effective contraceptive plan well before filling a prescription for oral retinoids to prevent possible harmful effects in the future.