I am writing to highlight a concern that often goes unaddressed in everyday clinical practice: the inconsistent communication between healthcare professionals and people of childbearing potential, regarding the reproductive risks associated with long-term medications. This concern has emerged following the sodium valproate safety concerns and qualitative research I have undertaken, which explores how clinicians discuss these risks — if at all — when prescribing for chronic conditions.
By holding interviews with primary and secondary care prescribers, I found such conversations are typically reserved for medicines known to be potentially teratogenic. In many cases, these discussions only occur when a clear safety warning exists — such as those outlined in research findings, summary of product characteristics, or national patient safety alerts and pregnancy prevention programmes. Several barriers contribute to this, including limited consultation time, a lack of formal training and insufficient or unclear data on medication use during pregnancy. Clinicians also express concern that raising uncertain risks may deter patients from starting treatments that could otherwise be beneficial.
When these discussions do occur, they can be to be impromptu and inconsistent, relying heavily on the clinician’s experience and access to specialist resources or guidance. System-wide variability in how, when, and by whom this information is conveyed results in unequal experiences for patients, often influenced by geography, health literacy or assumptions about a patient’s personal circumstances.
There is a clear need for change to ensure these conversations are standard practice. System prompts, targeted training and a collaborative team approach can support this. Effective communication between organisations — using shared records, integrated digital systems and clear referral pathways — can ensure that people of childbearing potential are consistently informed about potential reproductive risks.
In particular, the development of unified, accessible guidance and improved integration of pharmacists and other healthcare professionals into this aspect of care could help to close the existing gaps.
Improving how we approach and communicate reproductive risks is essential to providing informed, equitable care. These conversations should not be left to chance or solely to individual discretion. This letter serves to prompt further dialogue and action in making reproductive health a routine consideration in prescribing practice.
Bhavna Halai, the chief pharmaceutical officer’s clinical fellow at the Care Quality Commission
