The multifaceted question of the prescription of antidepressants during pregnancy.

Abstract

We analyzed the prescription of antidepressants in a cohort of 87,213 pregnant women living in the suburban area of Paris, using a database provided by the French Health Insurance System (a national health system that covers 95% of the population). The analyses covered five time periods: the 4 months before becoming pregnant; the first, second and third trimester; and the 4 months after delivery. The antidepressant prescription rates in the five time periods were 2.46%, 1.16%, 0.60%, 0.46% and 2.02%, respectively. All two-way comparisons of antidepressant prescription rates between different time periods were statistically significant, including the higher prescription rate prior to pregnancy (2.46%) versus that after delivery (2.02%) (difference of 0.44%; 95%CI=0.30% to 0.58%). Prescription rates observed in pregnant women were significantly lower than in a comparable cohort of non-pregnant women randomly selected from the same database during the same period. One could surmise that women planning a pregnancy would voluntarily discontinue antidepressant treatment either based on their own initiative or on that of their physician. It is difficult to know whether or not this presumed discontinuation was justified by the clinical status of the individuals – an issue that would require detailed health services research to resolve. The stepwise decrease in antidepressant prescription rates during pregnancy is probably related to beliefs about the risk of a withdrawal syndrome in infants [7-9] and about the 6-fold increased risk of persistent pulmonary hypertension in neonates born to mothers who receive selective serotonin-reuptake inhibitors medication after the 20 th week of pregnancy. [10] Thus concern about a rare but major infant risk (pulmonary hypertension only occurs in 1 or 2 infants per 1000 live births) outbalances