Abstract
AimThe aim of this study was to assess the prevalence and patterns of exposure to antidepressants before, during and after pregnancy in a cohort including all pregnant women in Denmark between 1997 and 2010.MethodsWe performed a retrospective cohort study including 912 322 pregnancies. Information was retrieved from the Danish Birth Registry and The Register of Medicinal Product Statistics to identify women redeeming an antidepressant prescription during pregnancy. Exposure periods were based on standard treatment doses and dispensed pack sizes.ResultsWe identified 19 740 pregnancies exposed to an antidepressant at some point during pregnancy. The rate of exposure increased from 0.2% in 1997 to 3.2% in 2010. We found that the rate of exposure was halved during the first 3 months of pregnancy. In contrast, we describe a clear increase in exposure after pregnancy among pre-delivery treatment-naïve women.ConclusionsIn spite of uncertainty concerning antidepressants’ safety during pregnancy we find a 16-fold increase in exposure rates between 1997 and 2010. The rates describe a sharp decrease in exposure during pregnancy that is probably caused by physicians’ hesitation to prescribe antidepressants and women’s fear of unwanted effects on the unborn child. More studies are needed to clarify the consequences of antidepressant discontinuation during pregnancy.
Highlights
It is estimated that approximately 20% of women of childbearing age (25–45 years), [1,2] and up to 15% of pregnant women suffer from depressive symptoms [3,4]
Untreated depression during pregnancy is associated with a 6-fold risk increase of postpartum depression [4,9]
Research dealing with the consumption of antidepressants and subsequent pregnancy outcomes has indicated an increased risk of congenital malformations, and more notably heart defects [10,11,12,13,14,15,16,17,18,19,20,21,22]
Summary
It is estimated that approximately 20% of women of childbearing age (25–45 years), [1,2] and up to 15% of pregnant women suffer from depressive symptoms [3,4]. Untreated depression during pregnancy is associated with a 6-fold risk increase of postpartum depression [4,9]. The results are conflicting [12,14,17,18,19,23,24,25,26,27,28,29,30,31,32,33] and studies including up to a million pregnancies indicate little risk of congenital malformations [12], [17,19,31,32], or the possibility of confounding by indication [34]. Studies show a clear association between SSRI use and persistent pulmonary hypertension of the newborn [35], and no association with perinatal mortality [36,37]
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