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Br J Clin Pharmacol. 2018 Aug;84(8):1764-1775. doi: 10.1111/bcp.13608. Epub 2018 Jun 3.

Patterns of antidepressant use during pregnancy: a nationwide population-based cohort study.

Author information

1
team PHARMACOEPIDEMIOLOGY, Univ. Bordeaux, Inserm UMR 1219, Bordeaux Population Health Research Center, F-33000, Bordeaux, France.
2
Charles Perrens Hospital, F-33000, Bordeaux, France.
3
Clinical Pharmacology Department, U 1171 University Hospital of Lille, University of Lille, F-59000, Lille, France.
4
Clinical Pharmacology Department, Inserm UMR 1027, CIC Inserm 1436, Faculty of Medicine, University Hospital of Toulouse, F-31000, Toulouse, France.
5
Clinical Pharmacology, University Hospital of Bordeaux, F-33000, Bordeaux, France.

Abstract

AIMS:

We explored the patterns of antidepressant use during pregnancy.

METHODS:

A cohort of women who started a pregnancy in 2014 was identified using data from the French reimbursement healthcare system (covering approximately 99% of the population). Antidepressant usage (initiated before or during pregnancy) was assessed. Explored changes in antidepressant treatment were: associations, switches, discontinuation and resumption of antidepressants during pregnancy.

RESULTS:

The cohort included 766 508 pregnancies (755 519 women). Antidepressant use during pregnancy was 25.7 per 1000 [95% CI: 25.3-26.0]. New use concerned 3.9 per 1000 [95% CI: 3.7-4.0]; the most initiated class during pregnancy was selective serotonin reuptake inhibitors (SSRIs), while the most prescribed individual drug in second and third trimesters was amitriptyline, a tricyclic. Most changes were observed before pregnancy and during the first trimester: 63% of ongoing treatments in the year before pregnancy were discontinued before conception; 68% of treatments maintained after conception were discontinued during the first trimester; switches or antidepressant associations mostly occurred during the periconceptional period or during the first trimester. Regardless of initial antidepressant, switches to sertraline were the most frequent. Associations mainly consisted of a prescription of tri-/tetracyclic or mirtazapine/mianserin in addition to an SSRI. Discontinuation during pregnancy led to treatment resumption in 22% of pregnancies.

CONCLUSIONS:

These results suggest that pregnancy was planned or the treatment especially adapted in accordance with existing recommendations in a large proportion of women under antidepressants or in whom such treatments have been initiated after starting a pregnancy.

KEYWORDS:

antidepressive agents; drug utilization; insurance health reimbursement; pharmacoepidemiology; pregnancy

PMID:
29665098
PMCID:
PMC6046485
[Available on 2019-08-01]
DOI:
10.1111/bcp.13608

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