Association between Antidepressant Treatment during Pregnancy and Postpartum Self-Harm Ideation in Women with Psychiatric Disorders: A Cross-Sectional, Multinational Study.

Jennifer Vallee,Eline Mannino,Yih Wong,Hedvig Nordeng,Angela Lupattelli

doi:10.3390/ijerph18010046

Abstract

This study sought to estimate whether there is a preventative association between antidepressants during pregnancy and postpartum self-harm ideation (SHI), as this knowledge is to date unknown. Using the Multinational Medication Use in Pregnancy Study, we included a sample of mothers who were in the five weeks to one year postpartum period at the time of questionnaire completion, and reported preexisting or new onset depression and/or anxiety during pregnancy (n = 187). Frequency of postpartum SHI (‘often/sometimes’ = frequent, ‘hardly ever’ = sporadic, ‘never’) was measured via the Edinburgh Postnatal Depression Scale (EPDS) item 10, which reads “The thought of harming myself has occurred to me”. Mothers reported their antidepressant use in pregnancy retrospectively. Overall, 52.9% of women took an antidepressant during pregnancy. Frequent SHI postpartum was reported by 15.2% of non-medicated women and 22.0% of women on past antidepressant treatment in pregnancy; this proportion was higher following a single trimester treatment compared to three trimesters (36.3% versus 18.0%). There was no preventative association of antidepressant treatment in pregnancy on reporting frequent SHI postpartum (weighted RR: 1.90, 95% CI: 0.79, 4.56), relative to never/hardly ever SHI. In a population of women with antenatal depression/anxiety, there was no preventative association between past antidepressant treatment in pregnancy and reporting frequent SHI in the postpartum year. This analysis is only a first step in providing evidence to inform psychiatric disorder treatment decisions for pregnant women.

Highlights

During pregnancy, between 2% and 6% of women take antidepressants to treat perinatal psychiatric disorders, mainly depression and anxiety, and their use appears to be trending upward since the 1990s [1,2,3]
This study reports new knowledge on the association between antidepressant treatment in pregnancy and self-harm thoughts in the postpartum year
In a population of women who reported depression or anxiety during gestation, there was no evidence that antidepressant treatment in pregnancy was associated with a lower occurrence of frequent

Summary

Introduction

Between 2% and 6% of women take antidepressants to treat perinatal psychiatric disorders, mainly depression and anxiety, and their use appears to be trending upward since the 1990s [1,2,3]. The prevalence of SHI differs depending on the mental illness considered, case ascertainment methods, and geography, up to one in five women with a psychiatric disorder may experience an event of SHI in the postpartum period [10]. This high estimate is alarming as SHI causes direct harm to the mother, may impair her ability to care for the child, and disrupts the welfare of the family as a whole [11].

Methods

Results

Conclusion