TESTING FOR PREGNANCY STATUS

To affirm that pregnancy testing should occur only with the patient’s informed consent or assent, when feasible, and only when the test results would change medical management; further,

To affirm that a positive pregnancy test should not compromise the integrity of evidence-based, patient-centered care.

Rationale

Screening and testing for the pregnancy status of patients prior to admission to a hospital or surgical center or before initiation of a teratogenic drug therapy has long been a routine practice, as the pregnancy status of a patient has many ethical and legal considerations when medical management is considered for patient care. Chief pharmacy officers often oversee laboratory medicine departments, and pharmacists are often involved in creating protocols and order sets in which pregnancy testing and screenings are embedded. As a result, pharmacists are key stakeholders in this practice.

It is important to note that this policy pertains to testing without informed consent or assent when therapy may need to be changed due to a positive test. The balance between unnecessary testing and testing when initiating a medication therapy is supported by a 2015 study that found that pregnancy assessment was underutilized in the emergency department when patients were prescribed a pregnancy category D or X drug. This policy does not advocate that healthcare professionals should not include pregnancy screening as a part of a patient history, only that pregnancy testing should occur only with informed consent or assent and not be a requirement for care. The incidence of unknown pregnancy in adult women presenting to a hospital for surgical procedures varies from 0.125 to 1.2%, depending on the procedure. It is important to note that testing should occur when feasible, as care should not be delayed in emergent or urgent scenarios.

This policy also aligns ASHP with the American Society of Anesthesiologists statement that recommends “pregnancy testing may be offered to female sex patients of childbearing age and for whom the result would alter the patient’s management, but testing should not be mandatory. Informed consent or assent of the risks, benefits, and alternatives related to preoperative pregnancy testing should ideally be obtained. Best practice may employ shared decision-making between patients and providers.”