Abstract
BackgroundThe purpose was to describe utilization of selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), including trends in prevalence, characteristics of users, drug switching and changes in prescribed doses in a large group of pregnant women across four Nordic countries.MethodsA drug utilization study based on linked individual-level data from the nationwide prescription- and medical birth registers in Denmark, Iceland, Norway and Sweden. The study population comprised all pregnancies in these countries, resulting in a live birth or stillbirth after gestational week 22 from January 1st 2008 to December 31st 2012 (N = 1 162 470). In addition to the main study drugs SSRIs and SNRIs, we included (concurrent) use of other antidepressants, antipsychotics, anxiolytics and hypnotics.ResultsA total of 38 219 (3.3%) pregnancies were exposed to SSRIs and 5 634 (0.5%) to SNRIs. Prevalence of SSRI and SNRI use varied by country (1.8% in Norway to 7.0% in Iceland). Use and prescribed dosages decreased with each passing trimester of pregnancy; prevalence was 2.7% at conception, and 2.1%, 1.7% and 1.3% respectively in 1st, 2nd and 3rd trimester. In 0.6% of pregnancies women filled a prescription before pregnancy and in every trimester. In one third of exposed pregnancies, women were also dispensed anxiolytics, hypnotics or sedatives.ConclusionUse of SSRI and SNRI use during pregnancy varied between the Nordic countries, but the overall prevalence remained low and relatively stable from 2008 to 2012. The low prevalence of use and high proportion of women who discontinue treatment in pregnancy raise questions about adequate treatment of depression in pregnant women.
Highlights
Depression is estimated to occur in 7–15% of pregnancies in economically developed countries [1, 2]
As defined above, we described the prevalence and patterns of SSRI/serotonin–norepinephrine reuptake inhibitors (SNRIs) use in pregnancy by drug group (SSRI, SNRI), specific substances (S1 Table), calendar year, maternal country of residence (Denmark, Iceland, Norway, Sweden), age ( 24, 25–34, 35–44, !45 years), parity (0, 1, 2, 3, !4), relationship status, smoking status during early pregnancy and multiple pregnancy, i.e. pregnancies which led to birth of twins, triplets, etc
The changes in patterns of SSRI/SNRI use and dosages from before last menstrual period (LMP) to early pregnancy remained nearly the same in an additional analysis, where early pregnancy was defined as pregnancy weeks 5–13, as in the main analysis. In this large population-based study covering over 1.1 million pregnancies, carried to at least gestational week 22, in four Nordic countries, we found an overall 3.6% prevalence of SSRI and SNRI use among pregnant women, varying over 3-fold between countries
Summary
Depression is estimated to occur in 7–15% of pregnancies in economically developed countries [1, 2]. Selective serotonin reuptake inhibitors (SSRIs) are the most frequently used antidepressants in pregnant women, with an estimated 2–3% of women in Europe and 4–10% in North America receiving such drugs during pregnancy [3,4,5,6,7,8]. The European Medical Agency (EMA) and Food and Drug Administration (FDA) in the United States have issued warnings regarding use of SSRIs during late pregnancy and increased risk of persistent pulmonary hypertension in the newborn, as well as warnings of increased risk of congenital malformations, cardiac defects, in association with exposure to paroxetine and fluoxetine during first trimester. The purpose was to describe utilization of selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), including trends in prevalence, characteristics of users, drug switching and changes in prescribed doses in a large group of pregnant women across four Nordic countries.
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