TERMINATIONS OF PREGNANCY FOR EXPOSURE TO ORAL RETINOIDS IN SOUTH-AUSTRALIA, 1985-1993

The oral retinoids, isotretinoin and etretinate, are highly teratogeni c drugs which have been available in Australia since 1985 because of t heir unique effectiveness in severe cystic acne, psoriasis and other k eratinization disorders. Only dermatologists can prescribe them, but i n spite of strict guidelines by the manufacturers and the College of D ermatologists, exposed pregnancies have occurred. We attempted to dete rmine the circumstances of exposure to these drugs for the 18 pregnanc ies terminated in South Australia in 1985-1993, using questionnaires t o medical practitioners who notified the terminations under legislatio n. The main reason for their occurrence was the lack of compliance wit h the use of effective contraception by the women. In South Australia, some prescriptions of oral retinoids by unauthorized doctors have bee n dispensed during this period. Using statistics on prescriptions disp ensed, an estimate was made of 1 termination of pregnancy for 319 cour ses of treatment for women with isotretinoin. Extension of guidelines for prescription and more detailed counselling in relation to the use of contraception are recommended, It is also suggested that doctors in tending to recommend terminations obtain consent to discuss exposure w ith the dermatologists concerned, who may not be aware of the exposed pregnancy.