Patterns and predictors for prescription of psychotropics and mood‐stabilizing antiepileptics during pregnancy in Denmark 2000–2016

Damkier, Per; Christensen, Louise Skov; Broe, Anne

doi:10.1111/bcp.13732

Cited by 14 publications

(13 citation statements)

References 44 publications

(57 reference statements)

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“…1 Flowchart over the study design. 1 Women with pre-pregnancy diabetes mellitus (type 1 or 2). 2 Use of valproate during pregnancy.…”

Section: Drug Exposurementioning

confidence: 99%

“…The use of second-generation antipsychotic drugs (S-GAs) has more than doubled in the last decade, mainly explained by a wider spectrum of indications than for the first-generation antipsychotics (F-GAs), for example bipolar disorder [1][2][3][4][5][6][7]. The S-GAs have less extrapyramidal and prolactin-related side effects than F-GAs, but there are concerns regarding their metabolic side effects [8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Antipsychotic Use During Pregnancy and Risk for Gestational Diabetes: A National Register-Based Cohort Study in Sweden

et al. 2022

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Objective We aimed to study whether antipsychotic use during pregnancy is associated with gestational diabetes. Methods This was a Swedish national register-based cohort study on the Medical Birth Register and the Prescribed Drug Register including all 1,307,487 singleton births between July 2006 and December 2017. Antipsychotics were divided into first-generation antipsychotics (n = 728), high-risk metabolic second-generation antipsychotics including olanzapine, clozapine and quetiapine (n = 1710), and other second-generation antipsychotics (n = 541). The risks for gestational diabetes, foetal growth disturbances, pre-eclampsia, caesarean section and preterm labour were assessed. Women treated during pregnancy were compared to women not treated during pregnancy and to women who used antipsychotics before/after but not during pregnancy. ResultsThe crude risk ratio for gestational diabetes for women treated with high-risk metabolic second-generation antipsychotics during pregnancy was 2.2 (95% confidence interval [CI] 1.6-2.9) compared to untreated pregnant women (n = 1,296,539) and 1.8 (95% CI 1.4-2.5) compared to women treated before/after pregnancy (n = 34,492). After adjustment for maternal factors including body mass index, the risk ratios were 1.8 (95% CI 1.3-2.4) and 1.6 (95% CI 1.2-2.1). Exposed infants had an increased risk of being large for gestational age: adjusted risk ratios 1.6 (95% CI 1.3-1.9) and 1.3 (95% CI 1.1-1.6) compared to no maternal antipsychotic use during pregnancy and maternal use before/after the pregnancy. Other antipsychotics were not associated with metabolic risks. Conclusions Olanzapine, clozapine and quetiapine used during pregnancy were associated with increased risks for gestational diabetes and the infant being large for gestational age. Enhanced metabolic monitoring should be considered for pregnant women using these drugs.

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“…1 Flowchart over the study design. 1 Women with pre-pregnancy diabetes mellitus (type 1 or 2). 2 Use of valproate during pregnancy.…”

Section: Drug Exposurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antipsychotic Use During Pregnancy and Risk for Gestational Diabetes: A National Register-Based Cohort Study in Sweden

et al. 2022

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“…In such a context, the relationship between changes in antiepileptic drug prescribing during pregnancy and risk of malformation has become a public health interest in a few countries. [16][17][18][19][20][21][22] We performed a descriptive, population-based pharmacoepidemiological study using data from administrative healthcare databases aimed to evaluate prescription profiles of AEDs in an Italian population of women in childbearing age and pregnant women.…”

Section: Introductionmentioning

confidence: 99%

Changes in antiepileptic drug prescriptions over a decade in childbearing women in Lombardy region, Italy

Clavenna

Campi

Putignano

et al. 2021

Brit J Clinical Pharma

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Aims To describe the antiepileptic drug (AED) prescription pattern in pregnant women and women of childbearing age in the 2010–2019 period in the Lombardy region, Italy. Methods The Lombardy region administrative healthcare databases (2010–2019) were analysed. AEDs were classified as drugs belonging to the N03A subgroup of the Anatomical Therapeutic Chemical Classification System. Women aged 15–49 years were considered as being of childbearing age, while exposure during pregnancy was estimated taking into account the 12 months before delivery (International Classification of Diseases, Ninth Revision, Clinical Modification, ICD‐9‐CM codes in the diagnosis record from 650 to 659). Results During 2019, 16 605 women of childbearing age (prevalence: 14.8‰) received at least 1 AED prescription. Pregabalin was the most widely used antiepileptic in women of childbearing age (22.3%), followed by valproic acid (20.0%). In 2010, the prevalence of valproic acid prescription to women of childbearing age was 30.2%; in 2019 this was 20.0%. In pregnant women, this prevalence was 24.9% in 2010 and 14.1% in 2019. Starting from 2017, levetiracetam and lamotrigine were the most commonly drugs prescribed to pregnant women. Conclusion Despite the decrease in valproic acid prescription over time, this drug is still among the most used AEDs, in particular in women of childbearing age. Educational interventions for healthcare professionals and women are needed in order to reduce the risk of unplanned pregnancy.

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“…Antidepressants are frequently used in the treatment of depression and anxiety disorders. Epidemiological studies suggested that antidepressant usage among pregnant women increased by 3‐ to 7‐fold in the past 2 decades and that up to 13% of fetuses are exposed to antidepressants 9‐11 . Although there are controversial results and low absolute risks reported in the literature, concerns still continue about the use of antidepressants during pregnancy.…”

mentioning

confidence: 99%

“…Epidemiological studies suggested that antidepressant usage among pregnant women increased by 3-to 7-fold in the past 2 decades and that up to 13% of fetuses are exposed to antidepressants. [9][10][11] Although there are controversial results and low absolute risks reported in the literature, concerns still continue about the use of antidepressants during pregnancy. In the past 2 decades, the body of published data on the use of antidepressants during pregnancy from epidemiological and clinical investigations has dramatically increased.…”

mentioning

confidence: 99%

Neonatal and Childhood Outcomes in Offspring of Pregnant Women Using Antidepressant Medications: A Critical Review of Current Meta‐Analyses

Uğuz

2020

The Journal of Clinical Pharma

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This article reviewed the results of 21 recent meta‐analyses examining the relationship between maternal use of antidepressants during pregnancy and negative outcomes in newborns and children. PubMed was searched for meta‐analyses published in English between January 1, 2011, and November 30, 2019, by using combinations of the keywords pregnancy, antidepressants, review, meta‐analysis, selective serotonin reuptake inhibitors, selective serotonin‐norepinephrine reuptake inhibitors, tricyclic antidepressants, neonatal outcomes, autism spectrum disorders, attention deficit hyperactivity disorder (ADHD), preterm birth, low birth weight, spontaneous abortion, persistent pulmonary hypertension, infant, newborn, children, and offspring. The present review included a total of 21 relevant meta‐analyses that met the inclusion criteria. Most of the meta‐analyses reported that compared to non‐users, the risks of preterm birth, low birth weight, spontaneous abortion, persistent pulmonary hypertension, autism spectrum disorders, and ADHD in offspring of antidepressant users were significantly higher. Some meta‐analyses also noted that the elevated risks were no longer statistically significant when pregnant women with psychiatric diagnoses treated with an antidepressant were compared with control patients who remained untreated. Although this review of current meta‐analyses suggests a moderately increased risk of neonatal and childhood outcomes assessed with maternal use of antidepressants, it is difficult to ascertain whether these outcomes are independent of underlying maternal psychiatric disorders.

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Patterns and predictors for prescription of psychotropics and mood‐stabilizing antiepileptics during pregnancy in Denmark 2000–2016

Abstract: The use of APs, ADs and mood-stabilizing AEDs during pregnancy has increased substantially in Denmark from 2000-2016. The use of ADs appears to be slightly in decline since 2011.

Cited by 14 publications

References 44 publications

Antipsychotic Use During Pregnancy and Risk for Gestational Diabetes: A National Register-Based Cohort Study in Sweden

Antipsychotic Use During Pregnancy and Risk for Gestational Diabetes: A National Register-Based Cohort Study in Sweden

Changes in antiepileptic drug prescriptions over a decade in childbearing women in Lombardy region, Italy

Neonatal and Childhood Outcomes in Offspring of Pregnant Women Using Antidepressant Medications: A Critical Review of Current Meta‐Analyses

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