Twenty-five years of counseling family physicians What have we learned?

QUESTION In 1985, for the first time I asked Motherisk for advice regarding a pregnant patient who, unaware of her pregnancy, had taken tetracycline. I was very concerned, as was my patient, who was ready to terminate a wanted pregnancy for fear that she had harmed her baby. As a direct result of your advice, this "fetus" is now a happy 25-year-old mother of a healthy son. Your answer to me was as follows: This woman was exposed to tetracycline long before the teeth buds were formed; therefore, there was no apparent fetal risk. What do you think is some of the most important information you have given to practising family physicians over the past 25 years? ANSWER Unfortunately, too many decisions regarding management of pregnant women are based on misinformation or misconceptions of teratogenic risk. It is critical to base therapeutic decisions regarding exposures during pregnancy on balancing risks of untreated maternal disease with the existing evidence-based information on fetal safety.