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National Network Provides Teratology Services

Kate Traynor

A little-publicized nationwide resource offers information about the risks of fetal exposure to drugs, chemicals, and other agents.

"We’ll answer any question that comes in on exposures during pregnancy—that would be anything from medication through environmental exposures, illnesses, occupational exposures," said Elizabeth Rudy, D.V.M., a clinical pharmacist who works for CARE Northwest, a teratology information service. "Pretty much anything that comes in, we’ll tackle," she said.

Housed in Seattle at the University of Washington, CARE Northwest is one of 26 local organizations that operate in the United States under the umbrella of OTIS, the Organization of Teratology Information Services. Two additional OTIS member groups operate in Canada.

Janine E. Polifka, Ph.D., codirector of CARE Northwest and incoming president of OTIS, said that the teratology information service sites are staffed by medical geneticists, nurses, and other health professionals.

"They have expertise in teratology," Polifka said in describing her colleagues. "They understand how drugs interfere with embryogenesis and how they can affect development."

People who work at the OTIS member services keep up with teratology information by monitoring medical literature and reproductive databases that contain exposure information.

"We’re very current," said Rudy, who also works part time at the University of Washington's drug information service. "We have access to all the latest information."

Polifka said many of CARE Northwest’s calls come from pregnant women asking if they can safely take cold medications or antidepressants. CARE Northwest also receives calls from health care providers who are concerned about risks to the fetus when a pregnant woman needs medical treatment.

"You get dentists who want to maybe give their patient lidocaine," Polifka said. Other typical calls include questions about diagnostic radiology. "A lot of the physicians call about the antidepressants as well," Polifka added.

Rudy estimated that her teratology service handles about 80 telephone consultations each month and sets up an occasional live counseling session.

"If we have somebody that’s exposed to something—to an anticonvulsant or some drug that’s a known teratogen—we will have them come in and counsel them face-to-face," she said. "If they’re out of state...we’ll refer them to a genetic counseling facility where they are, so they have some kind of follow-up."

Rudy and Polifka regard the work that the teratology services do as critical but said a lack of funding hinders their operating to the fullest extent.

"It’s really, really difficult for services like ours to get funding to operate," Polifka said. For this reason, she said, the various OTIS member groups operate under a diverse set of rules related to their funding source.

"Some of the services are part of the medical genetics department of a university," Polifka said. "They’ll only take calls from health care professionals."

In contrast, she said, "some services may be funded by the state department of health, in which case they can take calls from general public, but they can’t take calls from other states."

CARE Northwest, Rudy said, previously received funding from the state but is now funded by subscriptions and donations. This means that some callers must pay a fee to receive counseling.

"If they’re a patient of our subscribers, they don’t pay," Rudy said. But, she added, "if they are just the general public and they want information, we do have to charge. We have a 900-number which is eight dollars per call."

Despite the teratology services’ "precarious" financial state, Polifka said, staff members are dedicated to their work.

"The people who do this kind of thing really believe in the importance of the information," she said.

Rudy said that people with pharmacy training are well suited to the field of teratology. "A lot of our questions are on drugs and looking at the kinetics," she said. "I’d like to see more pharmacists in the field."