Problems with informing women adequately about teratogen risk: some barriers to preventing exposures to known teratogens

Drug safety in pregnant women and their babies: ignorance not bliss

Although clinical trials address questions regarding drug safety for most segments of the population, pregnant women constitute one special group that is "orphaned" with respect to this issue. The lack of adequate pregnancy safety information for the vast majority of medications, combined with a need to make appropriate treatment decisions and to communicate risk information to a potentially vulnerable population, are some of the most challenging and critical women's health issues.

Exploratory evaluation of several teratogen warning symbols

BACKGROUND

Previous research has noted potential inadequacies in the warning labels and symbols used with some teratogenic medications. A clear teratogen warning symbol represents an important component of risk mitigation for accidental teratogen exposure.

METHODS

Several teratogen warning symbols were developed through rapid prototyping and focus groups. A nationally distributed field trial (n = 300) examined the relative effectiveness of 6 candidate symbols, including the symbol in use at the time of the study. Measures included open-ended interpretation, closed-ended preference, and demographic surveys. Each participant was shown a single symbol and asked what it meant, to whom it applied, and what that person should do. Text statements were added to the symbol and participants were asked to reinterpret the warning. Participants were told the intended message of the warning, shown all 6 symbols, and asked to choose the most effective symbol.

RESULTS

Four of 6 symbols achieved levels of correct interpretation close to or exceeding the American National Standards Institute (ANSI) benchmark of 85% and none exceeded the ANSI limit of 5% critical confusion. Symbols elicited varying conceptual responses. Respondents considered 1 symbol to be the most effective, by a 4 to 1 margin. Several outcomes varied by age and by ethnicity.

CONCLUSIONS

Several symbols emerged as viable alternatives to the current symbol; however, no 1 symbol was clearly found to be the most effective. Instead, the symbol considered "best" depends on the messages that are considered most essential to the warning. Additionally, it appears a symbol without the addition of text can convey most, but possibly not all, of the meaning required of the warning label. Next steps should include further symbol refinement, closer examination of text additions to symbols, and validation of the candidate symbols and warnings through a large-scale field trial.