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A Concerning Internet Trend That Might Result in Unintended Pregnancy
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A Concerning Internet Trend That Might Result in Unintended Pregnancy Sam T. Ontiveros M.D. , Mariam Qozi Pharm.D , F. Lee Cantrell Pharm.D PII: DOI: Reference:
S0002-9343(20)30159-5 https://doi.org/10.1016/j.amjmed.2020.02.013 AJM 15627
To appear in:
The American Journal of Medicine
Please cite this article as: Sam T. Ontiveros M.D. , Mariam Qozi Pharm.D , F. Lee Cantrell Pharm.D , A Concerning Internet Trend That Might Result in Unintended Pregnancy, The American Journal of Medicine (2020), doi: https://doi.org/10.1016/j.amjmed.2020.02.013
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2020 Published by Elsevier Inc.
A Concerning Internet Trend That Might Result in Unintended Pregnancy
Sam T. Ontiveros, M.D.a, Mariam Qozi, Pharm.Db, F. Lee Cantrell, Pharm.Da,b
a. The Division of Medical Toxicology, Department of Emergency Medicine UCSD Medical Center, 200 W. Arbor Drive #8676, San Diego, CA 92103, USA. b. California Poison Control System, 200 W. Arbor Drive, San Diego, CA 92103, USA
Corresponding Author: Sam Ontiveros, electronic address: [email protected]. Phone: (831) 818-5027. Postal address: 200 W. Arbor Drive #8676, San Diego, CA 92103, USA.
The authors had access to all data and were involved in all aspects of this Clinical Communication to the Editor’s preparation. They have no conflicts of interest to disclose and received no financial support in the preparation of this manuscript.
Keywords: pregnancy, plan b, emergency contraception, home pregnancy testing, social media, poison control system, undesired pregnancy
Running header: Concerning Internet Trend
To the Editor, Emergency contraception and home pregnancy tests are commonplace with both being available without a prescription. Oral emergency contraception formulations available in the United States typically contain levonorgestral or ulipristal acetate which prevent ovulation1. Over-the-counter home pregnancy tests are generally reliable and accurate in identifying pregnancy through detection of urinary human chorionic gonadotropin2. Home pregnancy tests are packaged into small strips with a plastic casing containing reagents, an absorbent test pad, results display, and a desiccant to prevent product degradation in storage. Recently, the idea that home pregnancy tests kits secretly contain an emergency contraceptive pill inside their casing has been promoted on social media. Specifically, several Tiktok and Youtube videos show users breaking open Clearblue® home pregnancy tests to reveal a pill shaped desiccant within. We report a case of this newly popularized urban myth. An 18-year-old female broke open a Clearblue® home pregnancy test and ingested the pill shaped desiccant inside. A friend had told her to take it as a “morning after pill”. This friend had reportedly ingested the same tablet on 6 prior occasions without any adverse effects. Fifteen minutes post-ingestion, our patient became concerned and called poison control after reading several articles that debunked the idea and advised seeking medical attention. The patient was asymptomatic, and since desiccants are generally non-toxic and have no physiologic activity, no treatment was required. Nearly 45% of the 6.1 million pregnancies in the United states are unintended3. Patients incorrectly ingesting home pregnancy test desiccants as a pregnancy prevention method may
worsen that number. Additionally, patients of lower socioeconomic status, who may already lack reliable access to good health information, may be disproportionally affected by the fact that home pregnancy tests could be a cheaper ($12) option than traditional emergency contraception pills ($50). Unfortunately, the internet has quickly become many patients’ primary resource for medical information. Dangerous practices such as using dinitrophenol for weight loss, “vodka eyeballing”, the “cinnamon challenge” and “planking have all resulted in medical consequences4,5,6 7. While several parenting websites and forums have attempted to debunk the original claims, the misuse of Clearblue® home pregnancy tests continues to be perpetuated on social media. In order to avoid unintended pregnancies, clinicians should be familiar with this ineffective urban myth and be prepared to provide adequate post-exposure counselling.
References: 1. Brache V, Cochon L, Deniaud M, Croxatto HB. Ulipristal acetate prevents ovulation more effectively than levonorgestrel: analysis of pooled data from three randomized trials of emergency contraception regimens. Contraception 2013; 88:611. 2. Cole LA, Khanlian SA, Sutton JM, et al. Accuracy of home pregnancy tests at the time of missed menses. Am J Obstet Gynecol 2004; 190:100. 3. Finer LB and Zolna MR, Declines in unintended pregnancy in the United States, 2008–2011, New England Journal of Medicine, 2016, 374(9):843–852, doi:10.1056/NEJMsa1506575
4. Grundlingh, J., Dargan, P.I., El-Zanfaly, M. et al. 2,4-Dinitrophenol (DNP): A Weight Loss Agent with Significant Acute Toxicity and Risk of Death J. Med. Toxicol. 2011, 7: 205. 5. Bersani, S. Corazza, O. Albano, G. Bruschi, S. Minichino, A. Vicinanza, R. Bersani, G. Martinotti, G. Schifano, F. The “Eyeballing” technique: an emerging and alerting trend of alcohol misuse. European Review for Medical and Pharmacological Sciences. vol. 19. no. 12. pp. 2311-2317. 2015. 6. Amelia Grant-Alfieri, Judy Schaechter, Steven E. Lipshultz. Ingesting and Aspirating Dry Cinnamon by Children and Adolescents: The “Cinnamon Challenge”. Pediatrics May 2013, 131 (5) 833-835; DOI: 10.1542/peds.2012-3418 7. Barbieri S, Feltracco P, Omizzolo L, et al. Planking or the “Lying-Down Game:” Two Case Reports. Interact J Med Res 2017;6(1):e4
A Concerning Internet Trend That Might Result in Unintended Pregnancy Sam T. Ontiveros M.D. , Mariam Qozi Pharm.D , F. Lee Cantrell Pharm.D PII: DOI: Reference:
S0002-9343(20)30159-5 https://doi.org/10.1016/j.amjmed.2020.02.013 AJM 15627
To appear in:
The American Journal of Medicine
Please cite this article as: Sam T. Ontiveros M.D. , Mariam Qozi Pharm.D , F. Lee Cantrell Pharm.D , A Concerning Internet Trend That Might Result in Unintended Pregnancy, The American Journal of Medicine (2020), doi: https://doi.org/10.1016/j.amjmed.2020.02.013
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2020 Published by Elsevier Inc.
A Concerning Internet Trend That Might Result in Unintended Pregnancy
Sam T. Ontiveros, M.D.a, Mariam Qozi, Pharm.Db, F. Lee Cantrell, Pharm.Da,b
a. The Division of Medical Toxicology, Department of Emergency Medicine UCSD Medical Center, 200 W. Arbor Drive #8676, San Diego, CA 92103, USA. b. California Poison Control System, 200 W. Arbor Drive, San Diego, CA 92103, USA
Corresponding Author: Sam Ontiveros, electronic address: [email protected]. Phone: (831) 818-5027. Postal address: 200 W. Arbor Drive #8676, San Diego, CA 92103, USA.
The authors had access to all data and were involved in all aspects of this Clinical Communication to the Editor’s preparation. They have no conflicts of interest to disclose and received no financial support in the preparation of this manuscript.
Keywords: pregnancy, plan b, emergency contraception, home pregnancy testing, social media, poison control system, undesired pregnancy
Running header: Concerning Internet Trend
To the Editor, Emergency contraception and home pregnancy tests are commonplace with both being available without a prescription. Oral emergency contraception formulations available in the United States typically contain levonorgestral or ulipristal acetate which prevent ovulation1. Over-the-counter home pregnancy tests are generally reliable and accurate in identifying pregnancy through detection of urinary human chorionic gonadotropin2. Home pregnancy tests are packaged into small strips with a plastic casing containing reagents, an absorbent test pad, results display, and a desiccant to prevent product degradation in storage. Recently, the idea that home pregnancy tests kits secretly contain an emergency contraceptive pill inside their casing has been promoted on social media. Specifically, several Tiktok and Youtube videos show users breaking open Clearblue® home pregnancy tests to reveal a pill shaped desiccant within. We report a case of this newly popularized urban myth. An 18-year-old female broke open a Clearblue® home pregnancy test and ingested the pill shaped desiccant inside. A friend had told her to take it as a “morning after pill”. This friend had reportedly ingested the same tablet on 6 prior occasions without any adverse effects. Fifteen minutes post-ingestion, our patient became concerned and called poison control after reading several articles that debunked the idea and advised seeking medical attention. The patient was asymptomatic, and since desiccants are generally non-toxic and have no physiologic activity, no treatment was required. Nearly 45% of the 6.1 million pregnancies in the United states are unintended3. Patients incorrectly ingesting home pregnancy test desiccants as a pregnancy prevention method may
worsen that number. Additionally, patients of lower socioeconomic status, who may already lack reliable access to good health information, may be disproportionally affected by the fact that home pregnancy tests could be a cheaper ($12) option than traditional emergency contraception pills ($50). Unfortunately, the internet has quickly become many patients’ primary resource for medical information. Dangerous practices such as using dinitrophenol for weight loss, “vodka eyeballing”, the “cinnamon challenge” and “planking have all resulted in medical consequences4,5,6 7. While several parenting websites and forums have attempted to debunk the original claims, the misuse of Clearblue® home pregnancy tests continues to be perpetuated on social media. In order to avoid unintended pregnancies, clinicians should be familiar with this ineffective urban myth and be prepared to provide adequate post-exposure counselling.
References: 1. Brache V, Cochon L, Deniaud M, Croxatto HB. Ulipristal acetate prevents ovulation more effectively than levonorgestrel: analysis of pooled data from three randomized trials of emergency contraception regimens. Contraception 2013; 88:611. 2. Cole LA, Khanlian SA, Sutton JM, et al. Accuracy of home pregnancy tests at the time of missed menses. Am J Obstet Gynecol 2004; 190:100. 3. Finer LB and Zolna MR, Declines in unintended pregnancy in the United States, 2008–2011, New England Journal of Medicine, 2016, 374(9):843–852, doi:10.1056/NEJMsa1506575
4. Grundlingh, J., Dargan, P.I., El-Zanfaly, M. et al. 2,4-Dinitrophenol (DNP): A Weight Loss Agent with Significant Acute Toxicity and Risk of Death J. Med. Toxicol. 2011, 7: 205. 5. Bersani, S. Corazza, O. Albano, G. Bruschi, S. Minichino, A. Vicinanza, R. Bersani, G. Martinotti, G. Schifano, F. The “Eyeballing” technique: an emerging and alerting trend of alcohol misuse. European Review for Medical and Pharmacological Sciences. vol. 19. no. 12. pp. 2311-2317. 2015. 6. Amelia Grant-Alfieri, Judy Schaechter, Steven E. Lipshultz. Ingesting and Aspirating Dry Cinnamon by Children and Adolescents: The “Cinnamon Challenge”. Pediatrics May 2013, 131 (5) 833-835; DOI: 10.1542/peds.2012-3418 7. Barbieri S, Feltracco P, Omizzolo L, et al. Planking or the “Lying-Down Game:” Two Case Reports. Interact J Med Res 2017;6(1):e4