The critical need for clinical decision support systems for identification and management of teratogenic medications

To describe the critical need for clinical decision support systems to identify and manage use of potentially teratogenic medications in women of reproductive potential in the United States. Medline, CINAHL Plus, Academic Search Complete, International Pharmaceutical Abstracts, and the Cochrane Library databases were searched on November 1, 2018, with the key words (teratogen* OR birth defect OR Category D OR Category X OR (pregnancy or pregnant)) AND (clinical decision support OR decision support OR electronic record) to identify primary literature published in peer-reviewed journals describing clinical decision support systems implemented in outpatient settings in the United States to promote safe prescribing and clinician counseling for teratogenic medications. A hand search of the reference lists of relevant articles, including review articles, found through this search strategy was also performed. Despite the great potential for clinical decision support to assist clinicians in minimizing inadvertent fetal exposure to potentially teratogenic medications, there were only seven primary articles meeting the criteria. The results of these studies have shown some evidence of effectiveness yet had several notable limitations. No published clinical decision system showed great success. An eighth article, published in 2017, details the design of an intervention that had been implemented but not yet evaluated. There is a relative paucity of data regarding clinical decision support systems focused on teratogenic medications in the outpatient setting in the United States. Additional clinical decision support systems in this area need to be developed.