MONTREAL – Serious birth defects that strike as many as 2,000 babies each year in Quebec could be avoided, the author of a new study said Tuesday.

Researchers found that more than six per cent of pregnant Quebecers in the study took prescription drugs that are known to be dangerous for fetuses.

The research, led by Universite de Montreal, shows that half of the expectant mothers who consumed the potentially dangerous medications opted for abortions – a rate that was 11 per cent higher than for the rest of the population.

Lead author Anick Berard said these congenital malformations could be prevented with better communication between physicians and patients.

Berard, who believes the statistics are similar for pregnant women across the country, is urging governments to improve monitoring for drugs that pose a risk to embryos.

“Obviously, Canada has been riding on this risk-management program which is very weak, going on the good faith of the prescriber and the user,” said Berard, an epidemiologist from Universite de Montreal’s pharmacy department.

“Well, now we know that it does not work.”

The study, available online and to be published in an upcoming issue of the British Journal of Obstetrics and Gynaecology, examined data from 109,344 Quebec women, aged 15 to 45, who were pregnant between 1998 and 2002.

Researchers found that 6,871 of the pregnant women filled out at least one prescription for medications that are known to threaten fetuses.

Berard said the potentially dangerous substances include drugs to treat anxiety, epilepsy and severe acne.

As an example, she explained that some of the stronger acne medicines can increase the average three-per-cent risk of congenital malformations tenfold.

“You have 30 per cent chance of having a baby with a birth defect – which is huge, it’s one out of three,” Berard said.

She identified major defects as anything from a hole in a baby’s heart to a missing limb.

In the study’s sample, the rate of birth malformations in the general population was seven per cent. For the women who consumed the prescription drugs, it was more than eight per cent.

With roughly 80,000 births per year in Quebec, one percentage point can translate to between 800 and 2,000 birth malformations annually, Berard said.

“One per cent (one percentage point) is a lot of people – a lot of babies,” she said.

Berard believes the majority of these drugs were taken in the first weeks of unplanned pregnancies, when most women still don’t know they’re expecting. About half of Quebec pregnancies are unplanned.

The best way to prevent birth defects caused by prescription drugs? Plan your pregnancy, she said, and take oral contraceptives when necessary.

Berard said one of the major challenges is reaching out to sexually-active teenage girls, who often share acne medication without knowing the potential consequences if they get pregnant.

The Canadian Patient Safety Institute, a not-for-profit organization that advocates safer health-care practices, held a week-long campaign this month promoting communication in the health system.

“Good communication is key and it doesn’t matter whether it’s from the patient’s perspective or from the caregiver’s perspective,” said Paula Beard, the institute’s director of operations.

“Just because we’re talking about health care doesn’t make it any different than any other aspect of our life – good communication is a transferable skill no matter what.”

TORONTO – A significant proportion of HIV-positive women of child-bearing age want to become pregnant at some point in the future, a new study shows, although extra care is needed to prevent transmission of the virus to their babies.

The findings, to be published online Monday by the open access journal PLoS One, point to the need for more services and support for these women so they can have healthy children, researchers say.

The study focused on women in Ontario, and found that 69 per cent of those who responded to a detailed questionnaire expressed a desire to have a baby, while 57 per cent said they actually intend to become pregnant.

Dr. Mona Loutfy, an infectious disease specialist at Women’s College Hospital in Toronto who sees a lot of HIV-positive patients, and her colleagues recruited 490 women from 38 sites across Ontario to complete the survey between October 2007 and April 2009.

“When I was seeing my patients a lot of them were saying that they were interested in pregnancy,” she said in an interview.

“They weren’t being supported either by their family doctors or other doctors, or by the system, including fertility clinics.”

When HIV-AIDS appeared on the scene in North America in the 1980s, life expectancy for those afflicted was short and most HIV-positive women were focused on survival, not contemplating becoming pregnant.

That’s all changed and Loutfy noted that HIV can be “very well managed” today.

“We have 25 anti-HIV drugs, and if we use three of them in combination and the patients take their drugs and don’t miss pills, their life expectancy is now said to be similar to the general population,” she said.

“If a woman’s HIV-positive, we can give her the same drugs and ask her to not breastfeed and the baby has less than one per cent chance of getting infected with HIV.”

Studies involving hundreds of thousands of babies born to HIV-positive women taking antiretroviral drugs in the United States and France found that they had no problems compared to the general population, Loutfy said.

“So putting all that together, I think we’re at a point now where we can support HIV-positive women and men and couples with their pregnancy planning desires.”

A few years ago in British Columbia, a similar survey found only about 30 per cent of HIV-positive women were interested in pregnancy, Loutfy said.

She attributes the higher Ontario numbers to a different demographic that includes many immigrants from Africa and the Caribbean.

“They’re taking their medications, they’re working, while in British Columbia they have more of an intravenous drug-using population and an aboriginal population that gets HIV,” she explained.

There are numerous stumbling blocks for HIV-positive women who wish to become pregnant, according to Dr. Deborah Money, executive director of the Women’s Health Research Institute in British Columbia, and an expert in viral pathogens in women and pregnancy.

“In many cases it’s family members or friends, who if they share that desire with them, are aghast that they would think about having a baby when they have HIV – usually aghast from a position of not understanding what can be done, but there’s often lack of support,” she said.

“And then the medical community, depending on who they connect with, to say I’m positive and I’d like to have a baby, they may not get a positive response, or the right advice as to what can happen or what can be done.”

She said about 200 babies are born each year in Canada to HIV-positive women.

Fertility clinics are only starting to become comfortable in dealing with HIV-positive couples, Money noted, yet they can play a key role in the conception process if one partner is HIV-positive and the other needs to be protected from the virus.

If just the woman is HIV-positive, a syringe or “turkey baster” method can be used for insemination, according to Loutfy, and this can be done at home or with the assistance of a fertility clinic.

Dr. Matt Gysler, medical director of the ISIS Regional Fertility Centre in Mississauga, Ont., said that if a man is HIV-positive, he needs drug therapy to bring the viral count down, and a special technique is used to separate the sperm from fluid so that it’s likely to be non-infectious for insemination. These sperm preparations can cost between $200 and $400, he noted.

“Many of our HIV-positive patients are recent immigrants, some of them are not financially well-to-do … my opinion is that all fertility treatments should be covered,” he said.

“It’s very tough to sit in front of somebody who just can’t afford it.”

It was an “uphill battle” to convince his partners and lab and clinic staff to start taking HIV-positive patients three or four years ago because they feared contracting the virus or that other patients would walk out, he said.

But he won that battle, and now HIV-positive patients even travel from Montreal because they’ve had trouble finding clinics at home to serve them.

“There is a certain amount of fear and the need to set up procedures to deal with infectious patients,” he said. “Fundamentally, you just have to practise excellence in terms of contamination prevention.”

Loutfy said she surveyed 23 of 28 clinics registered with the Canadian Fertility and Andrology Society, and found about half were willing to see HIV-positive patients.

However, she found that only six of the 23 clinics offered the “sperm washing” technique described by Gysler.

TORONTO – Electronic medical records would be a huge help during pandemics because they allow doctors to quickly identify patients in high-risk categories, either by age or by underlying medical conditions, says interim eHealth Ontario president and CEO Rob Devitt.

Doctors in Peterborough are “pioneers” in using computerized records for their patients and had a much easier time identifying people who were in priority groups for the H1N1 vaccine than doctors who are still using paper records for every patient, Devitt said in a recent interview.

“Pre-(electronic medical records), if I wanted to call all my patients who were under six and those six to 18 with a chronic medical condition, I would have had to have someone come in and pull all these paper charts and go through each one, and of course miss stuff,” he said.

“Probably you wouldn’t even do it because it would be such a huge task, but (with electronic records) a couple of key strokes and it’s done.”

Ontario already has 3,300 physicians using electronic medical records for about four million patients. It plans to get that number up to 10,000 doctors covering 80 per cent of the province’s nearly 13 million people by 2012.

“We often hear Ontario is behind,” said Devitt. “That (four million) is more people covered by an electronic medical record than any other province.”

Devitt’s vision of an electronic records system that streamlines health care delivery in the province follows a challenging first year for eHealth.

Created after its predecessor agency, Smart Systems for Health, was quietly shut down after achieving very little in its first six years, the agency was mired in a scandal involving hundreds of millions of dollars in untendered contracts given to consultants.

The controversy cost a health minister his job – along with the CEO and the chairman of the eHealth board – and saw the auditor general issue a damning report on the agency’s spending and procurement practices.

It got so bad that employees at eHealth – the unsung “heroes” of electronic health records in Devitt’s eyes who had nothing to do with untendered contracts or expense account abuses – were afraid to tell people where they worked.

“I’ve had a number of staff tell me stories about what it was like going to the grocery store or the hockey rink and they’d be chatting with someone and say they worked at eHealth and suddenly the tone would turn,” he said.

“We’ve started a lot of work in trying to restore our internal mood and morale.”

Health Minister Deb Matthews, who was appointed after David Caplan was forced to step down, said the province won’t slow progress on electronic health records despite a $24.7-billion deficit.

Doctors can save on staff because they don’t need someone to copy and file all their paperwork after they switch to computerized records, said Matthews.

“It’s actually so cost-effective I think it’s one of those investments we just have to continue to build,” she said.

“Making investments that are transformational in nature, that down the road will deliver a more effective and stronger health-care system, that’s the kind of investment we just have to make.”

Still, getting doctors using computerized records is only one step towards creating a provincewide electronic health records that can be accessed and updated not only by physicians, but also by hospitals, community health centres, private clinics and pharmacies.

It’s a massive challenge that Devitt says will likely never really end as technology keeps improving.

The data that can be mined from the information gathered by eHealth can be pure gold and help save lives as well as precious health-care dollars, adds Devitt.

For example, it turns out there are 906,577 people with diabetes in Ontario – something no one knew before – and only one-third get the basic tests they should have for blood sugar levels and cholesterol as well as regular eye exams.

Regular tests can help reduce their greater risk of heart disease and blindness, and the data gathered will be turned into a diabetes registry for the province that eHealth hopes to have online by the fall of 2010.

Gathering similar data on other chronic conditions will be crucial, especially as the health-care system deals with the increasing demands of the aging baby boomers, said Devitt.

“The literature is crystal clear that chronic disease management is something health systems have not done well across the developed world and are also the way we’re going to be able to sustain our health systems,” he said.

“In the face of that demographic wave, the ability to have this sort of information to give better care is going to be crucial to sustain it.”

eHealth also plans to create electronic prescribing, where easily-forged paper prescriptions are eliminated and the doctor sends the prescription directly to the pharmacist, which will also help eliminate medication errors.

The Progressive Conservatives are still demanding a public inquiry into the problems at eHealth, saying taxpayers deserve to know why so little progress was made after $1 billion was spent on the effort to create electronic health records.

“The inquiry is necessary to take a look at what happened in the past and to find out exactly where the problems are and then plan forward,” said Opposition critic Christine Elliott.

“The government keeps pushing back their end date for completion (of electronic health records) and we don’t really have a clear idea why.”

The New Democrats say they too have concerns that the culture of entitlement at the agency hasn’t been completely stamped out.

“I don’t know that we’re there yet to be frank,” said NDP Leader Andrea Horwath.

“You can change people around, but if you still have that kind of culture there then you’re not going to get much change at all.”

Both Matthews and Devitt say the changes the government has made to eliminate untendered contracts and to have more work done by eHealth staff rather than consultants will help restore public confidence in the agency.