Pregnancy outcome of women who failed appointments at a teratogen information service clinic Benoit Bailey, MD, MSc, FRCPC a,1, *, Sylviane Forget, MD, FRCPC b , Gideon Koren, MD, ABMT, FRCPC c a Divisions of Clinical Pharmacology and Toxicology and Emergency Medicine, Department of Pediatrics, Ho ˆpital Ste-Justine and Universite ´ de Montre ´al, Montre ´al, Que ´bec, Canada b Division of Pediatric Gastroenterology, McGill University Health Center, Montre ´al, Que ´bec, Canada c Motherisk Program, Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada Received 25 July 2001; received in revised form 21 August 2001; accepted 1 September 2001 Abstract The effect of failed appointments at a teratogen information service (TIS) clinic on pregnancy outcome is not known. The objectives of our study were 1) to identify predictors of failed appointments and 2) to evaluate if failed appointments were associated with a higher rate of adverse pregnancy outcome among women booked for counseling at a TIS clinic over 5 consecutive months. Of 242 patients scheduled to come to clinic, 154 were followed-up at 20 weeks gestational age. Women who were pregnant at 20 weeks were more likely to have attended the clinic (81% attendance rate), than women who had a spontaneous abortion, a therapeutic abortion, or an ectopic pregnancy (54% attendance rate) (P = 0.003). Independent predictors of failed appointments included exposure to illicit drugs, history of previous spontaneous abortion, and a main concern that was a nonmedication exposure. In conclusion, pregnant women who failed appointments at a TIS clinic are at greater risk for not being pregnant at 20 weeks gestational age than those who attended the clinic. Telephone counseling should be considered in selected cases to ensure that all women get relevant information at the time of appointment booking. © 2002 Elsevier Science Inc. All rights reserved. Keywords: Failed appointment; Spontaneous abortion; Therapeutic abortion; Pregnancy outcome 1. Introduction The thalidomide and diethylstilbestrol disasters have led to fears among pregnant women of being exposed to med- ications. These fears have led women to believe that they were at a very high risk of fetal malformations despite being exposed to nonteratogenic drugs [1]. With appropriate counseling, it has been shown that this inaccurate perception of risk can be substantially reduced, thereby preventing numerous terminations of otherwise wanted pregnancies [1,2]. It is well known that lack of appropriate prenatal care is associated with adverse pregnancy outcome such as in- creased perinatal mortality, preterm delivery, and low birth weight [3,4]; however, the effect of failed appointments at a teratogen information service clinic on the estimation of such risks is not known. Furthermore, it has been shown that a physician’s ability to predict appointment keeping for prenatal care is poor [5]. In a similar manner, the predictors of failed appointments at a teratogen information service clinic are not known. If failure to come to such appoint- ments is not a random event, then women who failed the appointment may have different pregnancy outcomes than those who attend their appointment. If this is the case, then failure to include the first group may affect the results of epidemiologic studies based on the latter group. The objectives of our study were to evaluate the effect of failed appointments at a teratogen information service clinic on the estimates of pregnancy outcome and to describe factors associated with noncompliance with appointments. We hypothesized that women who failed their appointments would be at higher risk of therapeutic abortion. * Corresponding author. Tel.: +1-514-345-4931, ext 6276; fax: +1- 514-345-4823. E-mail address: baileyb@med.umontreal.ca (B. Bailey). 1 Benoit Bailey was supported by a fellowship from the Canadian Society for Clinical Pharmacology www.elsevier.com/locate/reprotox Reproductive Toxicology 16 (2002) 77– 80 0890-6238/02/$ – see front matter © 2002 Elsevier Science Inc. All rights reserved. PII: S0890-6238(02)00191-5