Commentary

OTIS Special Issue Preface

This special issue of Birth Defects Research: Clinical and Mo-lecular Teratology commemorates the 25th anniversary ofthe Organization of Teratology Information Specialists(OTIS). OTIS, a North American network of specializedcounseling services, was established in response to a‘‘grass roots’’ demand for evidence-based and individual-ized risk assessments regarding the wide variety of expo-sures occurring in pregnant or breastfeeding women.Now, 25 years later, it is a tribute to the value of this con-cept that, despite changing attitudes, advances in informa-tion technology, and challenging economic circumstances,the demand for OTIS services is stronger than ever.

The articles in this special issue fall into three groups.The first set includes critical reviews of informationregarding the effects of particular exposures on thedeveloping embryo or fetus. The second category pro-vides historical perspectives on teratogen informationservices, and the third group includes commentaries onissues that are important to teratogen risk counselors.

The critical reviews illustrate a range of counselingissues. Some of the agents are known to cause embryonicor fetal damage, but under circumstances that are differ-ent from those discussed (e.g., binge drinking or first-tri-mester maternal treatment with angiotensin-convertingenzyme inhibitors or angiotensin receptor antagonists),the counseling difficulty arises because of this differencein exposure conditions. Other exposures are of substan-tial theoretical concern (e.g., therapeutic use of neweranticonvulsant drugs or anti-tumor necrosis factor-alphatreatment during the first trimester of pregnancy), but acounseling dilemma arises because treatment may needto continue throughout pregnancy to maintain the health

of the mother. Other critical reviews discuss counselingdilemmas that arise in pregnant women with a particulardisease because of the availability of alternative treat-ments that have different risks and benefits (e.g., treat-ment of maternal hyperthyroidism in pregnancy) or thatinvolve exposures for which the data are not yet clear(e.g., prescription opioids, cancer chemotherapeuticagents, or selective serotonin reuptake inhibitors relativeto neurodevelopment).

The historical article in the second category providesinsights into the development of teratogen informationservices over the past three decades and into the diffi-culty of obtaining ongoing financial support for these im-portant endeavors.

Finally, the commentaries address concerns that affectwomen during pregnancy, one of the most importanttimes of their lives.

We believe that this special issue of Birth DefectsResearch is a fitting tribute to the 25th Anniversary ofOTIS. Like OTIS, the issue provides information that canhelp pregnant women to have healthy children.

Christina ChambersDepartment of Pediatrics

University of California San DiegoLa Jolla, CA

Jan M. FriedmanDepartment of Medical GeneticsUniversity of British Columbia

Vancouver, BC

Published online in Wiley Online Library (wileyonlinelibrary. com).DOI: 10.1002/bdra.23069

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