Thalidomide

What's the Problem?

Taken early in pregnancy, thalidomide can cause devastating birth defects in children, most particularly shortened arms and legs, often with no elbows or knees. In spite of its tragic history of affecting more than 10,000 babies in Europe in the 1950's and 1960's when the risks were unknown, thalidomide has recently become available again (by prescription in the U.S. and over the counter in South America). In many cases, only one dose early in pregnancy can cause harmful effects.

Who's at Risk?

Any woman who is already pregnant at the time of treatment with thalidomide or who becomes pregnant while using thalidomide could have a child with severe deformities. When the fetus is exposed to this drug during critical stages of development, limb and organ defects may result. Now that thalidomide has been approved by the FDA, there is the risk that it will be prescribed "off label" for other medical conditions at the discretion of physicians. Increased availability can lead to more frequent use by women of childbearing age, and, potentially, to the birth of infants with serious birth defects. Thalidomide should never be taken by women who are pregnant, planning to become pregnant, or who do not use very reliable forms of birth control.

Can It Be Prevented?

Yes. Thalidomide-affected pregnancies are completely preventable if proper precautions and guidelines are heeded. While it has been found to cause extreme malformations in unborn children, thalidomide also has a range of possible beneficial uses associated with fighting cancers, arthritis, tuberculosis, and many other diseases. Ironically, thalidomide's effectiveness at treating a wide range of illnesses may potentially make it more readily available to pregnant women, and therefore, a greater public health threat. Health care providers who prescribe thalidomide must ensure their female patients fully understand the need to avoid pregnancy while taking thalidomide. Health professionals also need to ensure a patient has a negative pregnancy test before writing a prescription for thalidomide.

Tips for Scripts

• INFORM viewers that only one dose of thalidomide may cause a fetus to suffer devastating effects.
• EDUCATE viewers about the importance of following all warnings on drug labels, and to listen carefully to their doctors about precautions.
• REMIND women that over 50% of pregnancies are unplanned or mistimed, so a woman being treated with a potentially harmful drug should take extra precautions.
• EXPLAIN to viewers that thalidomide-affected pregnancies are completely preventable.
• REASSURE viewers that being aware of the risks of certain drugs and following all recommendations to eliminate such risks can lead to a successful treatment without harm to a pregnancy.

Case Examples

1. A parent who has a child affected by a thalidomide birth defect will likely feel guilt, shame, and a great sense of loss. In addition, a thalidomide-affected pregnancy can cause conditions (such as a heart defect) that could lead to the child's death shortly after birth. (If a child is to become a regular part of this story, contact the Thalidomide Victims Association of Canada for information about the experiences and challenges of living with this disability.) Several circumstances that can lead a pregnant woman to unknowingly expose her baby to thalidomide can be dramatized:
   • A pharmacist makes an error in filling a prescription (potential litigation plot line).
   • A health care provider writes a prescription for thalidomide but fails to tell the woman to avoid pregnancy while taking the drug.
   • A pregnant woman with a drug dependency takes thalidomide from someone else's medicine cabinet.
   • A woman who is trying to become pregnant is maliciously given thalidomide by someone who wants to cause harm to her baby.
   • A woman taking thalidomide accidentally becomes pregnant as a result of contraceptive failure.
   • A woman is given a prescription for thalidomide but fails to wait for the pregnancy test result (which is positive) before starting treatment.
2. A woman being treated with thalidomide seeks health information from the Internet; she discovers the many risks associated with teratogenic drugs such as thalidomide. Horrified by the potential for birth defects, and angered by the lack of information she received from her physician, she switches physicians immediately. She discusses the need for greater awareness and educational outreach among physicians.