Pregnancy screening rates before teratogenic exposures are low for female adolescent patients with acute leukemia and those with emergency room (ER) visits including computer tomography (CT) of the abdomen/pelvis, a study in Cancer has shown.1
Because adolescents may be sexually active, pregnancy should be ruled out before exposure to teratogenic chemotherapy or abdominal/pelvic CT; however, no data are available on pregnancy screening patterns in this patient group.
In this study, researchers analyzed data from the Pediatric Health Information System from 1999 to 2011 on a cohort of female adolescents, 10 to 18 years old, with newly diagnosed acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML), and a cohort of same age females who had an ER visit with abdominal/pelvic CT.
Primary outcome measure was a pregnancy test billed on the same day or before the teratogenic exposure. Pregnancy screening was compared in the leukemia cohorts and ER cohort, with prevalence ratios and 95% confidence intervals (CIs) computed with log-binomial regressions.
The researchers identified 35,650 admissions that met their criteria. Appropriately timed pregnancy tests were obtained from 35% of the patients with ALL (n = 889), 64% of the patients with AML (n = 127), and 58% of patients in the ER cohort (n = 34,634).
Compared with the patients in the ER cohort, patients in the ALL cohort were significantly less likely to undergo pregnancy screening (adjusted prevalence ratio, 0.71; 95% CI, 0.65-0.78), but no significant difference was seen between the ER cohort and the patients in the AML cohort (adjusted prevalence ratio, 1.12; 95% CI, 0.99-1.27). The researchers noted substantial hospital-level variation in pregnancy screening patterns.
1. Rao P, Li Y, Getz KD, et al. Low rates of pregnancy screening in adolescents before teratogenic exposures in a national sample of children’s hospitals. Cancer. 2016 Sep 12. doi: 10.1002/cncr.30225. [Epub ahead of print]