Perceived risk of neurodevelopmental outcomes in offspring related to psychotropic and mental illness exposures in pregnancy and breastfeeding: a cross-sectional survey of women with past or current mental illness

Abstract

ObjectivesTo investigate the perceived risk of psychotropic and mental illness exposures (1) during pregnancy or (2) while breastfeeding on offspring neurodevelopment, and factors associated with this perception in women with past/current mental illness.DesignCross-sectional, web-based study.SettingNationwide in Norway, June 2020–June 2021.ParticipantsWomen aged 18–55 years who were pregnant, recent mothers or planning a pregnancy, and had been offered antidepressants in the last 5 years.Primary and secondary outcome measuresPerceived risk of prenatal and breastmilk exposure to psychotropic medications and maternal mental illness on offspring neurodevelopmental outcomes.ResultsWe included 448 women: 234 pregnant, 146 mothers and 68 planning a pregnancy. On a 0–10 scale, women perceived antidepressants as least harmful both (1) in pregnancy (mean score 4.2, 95% CI 3.6 to 4.8) and (2) while breastfeeding (mean score 3.8, 95% CI 3.3 to 4.4), relative to antipsychotics, anxiety/sleeping medication or antiepileptics (mean score range: 6.3–6.5 during pregnancy, 5.5–6.2 while breastfeeding). Many participants were unfamiliar with psychotropics other than antidepressants. The perceived risk of mental illness exposure exceeded that of antidepressants (mean score range 5.6–5.9) in both exposure periods. Using general linear models, factors associated with greater antidepressant risk perception in both exposure periods included having lower education, non-Norwegian native language, and employment status (range mean score difference (β): 2.07–6.07). For pregnant women and mothers, there was an inverse association between perceived risk and the perceived antidepressant effectiveness in both exposure periods (range of β: −0.18 to –0.25).ConclusionsIn women with past/current mental illness, the perceived risk of antidepressant exposure on child neurodevelopment was lower than that for maternal mental illness. Other psychotropic medications were perceived as more harmful. As medication risk perception influences the decision-making regarding treatment of mental illness, pre- and pregnancy counselling should target women with characteristics associated with higher perceived risk.

Treatment options and their uptake among women with symptoms of perinatal depression: exploratory study in Norway and Portugal

“…One prior study, using the same Norwegian data, applied survey weight adjustment (based on the most recent data from the Norwegian Health Directorate regarding the proportion of female patients having had contact with psychiatric clinics in all health regions), which affected results only minimally. 35 The two questionnaires in Norway and Portugal were generally identical, allowing uniform data collection and direct comparability of results. In addition, in both samples, the questionnaires were administered through a web-based platform, which may have prevented women with low digital literacy from participating in the study.…”

Assessing decisional conflict and challenges in decision-making among perinatal women using or considering using antidepressants during pregnancy—a mixed-methods study

“…Postnatal women having children older than one year of age may no longer face decisional conflict about AD treatment in pregnancy or while breastfeeding, and this may affect their recall about the pregnancy period. However, our study included only a small proportion of women with this characteristic and the DCS questions related specifically to the time around pregnancy (Bjørndal et al 2022 ). To further address this issue, we conducted all the analyses separately in pregnant and postnatal women, and results were consistent in both the groups.…”

“…Participants could choose to access the questionnaire anonymously or by using their national ID number. The complete questionnaire and information on recruitment methods have previously been published (Bjørndal et al 2022 ). The current study included only women who participated using their national ID numbers, as only these consented to participate in the qualitative phase of the study.…”

“…The main outcome of this study was decisional conflict, measured retrospectively in postnatal women and prospectively in pregnant women, using the Decisional Conflict Scale (DCS) (O’Connor and Jacobsen 2007 ) in the electronic questionnaire. Both pregnant and postnatal women were asked to report on their decision-making difficulties related to ADs in the pregnancy period (Bjørndal et al 2022 ). The DCS comprises 16 items measuring five dimensions of decision-making: feeling uncertain, uninformed, unclear about values, unsupported, and ineffective decision-making.…”

Partner support for women’s antidepressant treatment and its association with depressive symptoms in pregnant women, mothers, and women planning pregnancy

“…The questionnaire was administered via “Nettskjema” provided by the University of Oslo and was available to participants through pregnancy and motherhood-related websites, apps, social media, and brochures about the study distributed at various psychiatric outpatient and inpatient clinics, and maternal health clinics. The complete questionnaire and recruitment strategy have been published elsewhere (Bjørndal et al 2022 ). Women could participate in the study anonymously or by using their national ID number.…”