1. ORGANIZATION OF TERATOLOGY INFORMATION SPECIALISTS Sharon Voyer Lavigne, MS Coordinator, CT Pregnancy Exposure Information Service President, OTIS

2. North American Network of Telephone Services –Based in universities, hospitals and health departments –18 sites throughout U.S. and Canada –Provide services to approximately 100,000 women or health care providers each year –Pregnancy and breastfeeding exposures

3. Teratology Information Services (TIS) Comprehensive multidisciplinary resources Access to numerous specialists in: - teratology, dysmorphology, - toxicology, pharmacology, - epidemiology, infectious diseases, - clinical genetics, obstetric / maternal fetal medicine, - radiation biology, occupational and environmental health No cost services available to health-care providers and patients

4. Organization of Teratology Information Specialists Health care providers including: –Genetic counselors –Physicians –Nurses –Public health educators –Pharmacists –Social workers –Other specialties

5. TIS’s Provide Service – Toll-free phone consultation to patients or health care providers about exposures during pregnancy Education – to public and academic groups, including medical, nursing, genetic counseling, pharmacy and others Research – collaborative projects looking at outcomes of exposures to specific agents

6. SERVICE Telephone or in-person consultations that are free-of-charge and confidential Current data and risk assessment Information to help women make informed reproductive choices

7. Who calls a TIS: CALLER PROFILE: Patients 47% Health Care Providers 46% Relatives 4% General Public 2% Breastfeeding Mothers 1%

8. Common Exposures: Medications58% Occupational Agents17% Environmental Agents 8% Drugs of Abuse 6% Maternal Illness 4% Herbal Products 4% Radiation 3%

9. Reproductive Status: Pregnancy 74% Preconception9% Breastfeeding8% Not specified6% Paternal question3%

10. Developing a Risk Assessment Essential information: –Timing –Dose –Family, medical and pregnancy history –Other exposures

11. Literature Review Databases – REPROTOX, TERIS, Reprotext, Shepard’s Catalog Books – Briggs, Gleicher, Shardein, Hale Drug Compendiums, PDR, PDR for Herbals Journal articles

12. Providing a Risk Assessment Collection of data on specific agent Interpretation of data based on intake information Elicit callers’ knowledge and source Discuss 3-5% background risk Review risk vs. benefit

13. EDUCATION Public and health care provider workshops, seminars or lectures Student lectures (high school, college, etc) Fact Sheets (http://www.otispregnancy.org/) http://www.otispregnancy.org/ Professional education –Annual Education Conference –OTIS/Teratology Society/NBTS Joint Workshops

14. RESEARCH Autoimmune Diseases in Pregnancy Discontinuation of Antidepressant Medication During Pregnancy West Nile Virus and Pregnancy Vaccinations in Pregnancy CDC Pilot Project Isotretinoin Pregnancy Prevention Survey

15. OTIS and CDC –Grant funding for annual OTIS educational conference –Hurricane Katrina Project –Pilot Project for a Pregnancy and Lactation Monitoring System

16. www.otispregnancy.org National Phone Number: (866) 626-OTIS (866) 626-6847