# Women's Health Potentially Unsafe Medications or Exposures (Teratogens)

The current version of the VHA's Veterans Health Information Systems and Technology Architecture (VistA) and CPRS software does not provide any information to the provider that an item is teratogenic. Teratogens are drugs (including medications), chemicals, or other exposures, like radiation, that can interfere with normal embryonic/fetal development and thus, may lead to birth defects or pregnancy loss. In addition, there is a group of medications that pose a potential risk to breastfed infants.

The requested enhancements include the following:

- Ability to document a patient’s pregnancy status, intentions related to becoming pregnant (including methods of contraception), and breastfeeding status through both the Cover Sheet tab (using a new Women’s Health pane) and two new clinical reminder dialogs (Pregnancy/Intentions/Contraception and Update Lactation Status).

- Enhanced medication and radiology order checks that consider the patient’s pregnancy status (including likelihood of becoming pregnant) and the patient’s breastfeeding status.

- A new notification to the ordering provider of high-risk medications or radiology orders when a patient’s status changes to pregnant and/or changes to lactating.

- A new notification to the Women’s Health coordinator, the ordering provider, and the maternity care coordinator when a laboratory test for pregnancy is resulted or an ICD code is added to the patient’s chart indicating a pregnancy status or breastfeeding status that differs from what is documented. When processed, the notification will prompt the user to update the documented status if appropriate.

- A new VistA notification to the Women’s Health and Maternity Care coordinators when a note associated with a documented pregnancy status or documented lactation status is deleted, retracted, or reassigned. When processed, the notification prompts the user to review the documented status and perform a chart review to ensure that the status is still accurate.

- A new report (Women’s Health: Potentially Unsafe Medications, located in the Clinical Reports -> Pharmacy tree of reports) that lists the high-risk medications (both teratogenic and those that could harm breastfed infants) for female patients.