“Nevertheless, the low figure [for women using contraception while taking such medication] is concerning,” Lim said.
Roaccutane can cause birth defects.Credit: Craig Sillitoe
“[It] reinforces the ongoing need to educate patients and doctors about oral retinoids causing birth defects and the importance of effective contraception whilst on oral retinoids.”
Lim said he had never treated a patient who had become pregnant while on oral retinoids but it was known to happen.
He said GPs could play a greater role in counselling patients about contraception before referring them to dermatologists: “Dermatologists always flag the contraception/birth defect issue with patients.”
Rebecca Snow, who does not want her real name published for privacy reasons, became pregnant while taking Roaccutane in January.
It was a shock; while the then 19-year-old had not been using contraception, she had no plans to start a family with her partner.
She attended a high-risk pregnancy clinic at Nepean Hospital in western Sydney and was then referred to NSW pregnancy service MotherSafe, which provides counselling to women who have concerns about medication exposure.
She was told her unborn baby had a one in three chance of being born with abnormalities and was also at high risk of neurological issues.
“It was pretty overwhelming and confronting,” said the 20-year-old.
Rebecca said she would have continued with her pregnancy if her baby had not been at risk of serious harm.
Prescriptions for oral retinoids, such as popular acne medication Roaccutane, have almost doubled over the past nine years.Credit: iStock
Days before she was booked in for an abortion, when she was five weeks pregnant, she miscarried, which is another side effect of the medication.
While her dermatologist had told her she should use contraception when he prescribed her oral retinoids, Rebecca said he did not explain why.
“He didn’t detail the severity of falling pregnant,” she said. “I’d see the dermatologist every two months for a new script and I’d be shooed out within a few minutes.”
It’s not known exactly how often Australian women become pregnant while taking oral retinoids, how many of these pregnancies are terminated, how many result in a miscarriage and how many lead to babies being born with abnormalities.
MotherSafe director Dr Debra Kennedy receives at least 20 calls a year from distressed women who have fallen pregnant while taking oral retinoids.
‘The baby had multiple abnormalities and she had a termination. It was a really tragic case.’
Dr Debra Kennedy, MotherSafe
Kennedy, a co-author of the University of Sydney paper, decided to research the issue after being contacted by a teenager who became pregnant while taking oral retinoids.
“The doctors took her history in front of her mum and she wasn’t going to divulge that she was sexually active,” she said.
The teen discovered she was pregnant at the end of the first trimester, which is the period when oral retinoids have the most detrimental impact on a fetus.
“The baby had multiple abnormalities and she had a termination. It was a really tragic case.”
A spokeswoman for Roche, which makes Roaccutane, said the risks of using oral retinoids during pregnancy were well known.
“Roaccutane must not be used by females who are pregnant or who may possibly become pregnant while undergoing treatment,” she said.
“Pregnancy should be excluded before a patient starts Roaccutane and effective contraception is recommended before, during and after treatment.”