Psychotropic Drug Use before, during, and after Pregnancy: A Population-Based Study in a Canadian Cohort (2001-2013)

Leong, Christine; Raymond, Colette B; Château, Dan; Dahl, Matthew; Alessi‐Severini, Silvia; Falk, Jamie; Bugden, Shawn; Katz, Alan

doi:10.1177/0706743717711168

Cited by 30 publications

(28 citation statements)

References 22 publications

(44 reference statements)

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“…Increased data and knowledge on drug safety during pregnancy might be reflected by the decline observed for drugs labelled as D according to FDA classification, with special attention to psychotropics (ie, antidepressant, hypnotics, or antiepileptics). As previously reported, in the current study, the use of psychotropics suffered a marked decline within the first trimester compared with pre‐pregnancy period and a slightly decreased in the first trimester during the studied period, with the exception of antiepileptics . Still, we observed a higher proportion of women receiving at least one prescription of benzodiazepines (BZD) during the first trimester than expected .…”

Section: Discussionsupporting

confidence: 76%

An algorithm to identify pregnancies in BIFAP Primary Care database in Spain: Results from a cohort of 155 419 pregnancies

Ortiz

García

Astasio

et al. 2019

Pharmacoepidemiology and Drug

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Purpose: There has been a notable progress on the development of methods for identification of pregnancies using primary care databases. We aimed to evaluate the prescription of medications during pregnancy applying a novel algorithm. Methods:We identified pregnancies in women aged 15 to 49 years registered in the Database for Pharmacoepidemiological Research in Primary Care (BIFAP) between 2002 and 2015. The algorithm applied sequential cycles that searched in hierarchical order for indicators of conception, delivery or pregnancy loss, and other codes suggestive of pregnancy. Length of pregnancy was assessed by searching for last menstrual period (LMP) date, gestational age, and outcomes of pregnancy. Prescription of specific drugs during the pre-pregnancy period and first trimester and time trends during pregnancy were evaluated. Results:We identified a total of 155 419 pregnancies during the study period (77.5% completed pregnancies, 21.5% pregnancies losses, 0.8% ectopic pregnancies, and 0.2% stillbirths). Excluding vitamins and supplements, 43.8% of women received at least one prescription during the pre-pregnancy period and 68.4% during the first trimester. During the first trimester, the most commonly drugs prescribed were analgesics (16.3%) followed by antibiotics (11.8%). From 2002From /2003From to 2014From /2015 was an increase of prescriptions for thyroid hormones (1.0% vs 4.7%), H2 blockers (1.0% vs 2.2%), and PPIs (1.4% vs 2.2%). While antidepressants (2.0% vs 1.5%) and benzodiazepines (3.1% vs 2.4%) decreased in the last period. Conclusion:Having in mind the challenges of identifying pregnancies in health care databases, this study demonstrates the usefulness of BIFAP database for studies on drug utilization during pregnancy.

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Section: Discussionsupporting

confidence: 76%

An algorithm to identify pregnancies in BIFAP Primary Care database in Spain: Results from a cohort of 155 419 pregnancies

Ortiz

García

Astasio

et al. 2019

Pharmacoepidemiology and Drug

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“…Specifically, sertraline and fluoxetine were among the most commonly prescribed SSRIs, while bupropion was the most commonly prescribed non-SSRI antidepressant (Alwan, Reefhuis, Rasmussen, & Friedman, 2011). Anxiolytics and sedative-hypnotics together have been found to be the most common class of drugs used by pregnant women (Leong et al, 2017) with diazepam being the most commonly used anxiolytic in pregnancy (Leppee, Culig, Eric, Sijanovic, 2010). For treatment resistant depression, second generation antipsychotics and mood stabilizers have been used as augmenting agents or as a replacement to typical agents such as anti-depressants.…”

Section: Discussionmentioning

confidence: 99%

Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: A systematic review

Nillni

Mehralizade

Mayer

et al. 2018

Clinical Psychology Review

140

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Women with psychiatric disorders during pregnancy and the postpartum period (i.e., perinatal period) are at increased risk for adverse maternal and child outcomes. Effective treatment of psychiatric disorders during the perinatal period is imperative. This review summarizes the outcomes of 78 studies focused on the treatment of depression, anxiety, and trauma-related disorders during the perinatal period. The majority of studies focused on perinatal depression (n = 73). Of the five studies focused on anxiety or trauma-related disorders, only one was a randomized controlled trial (RCT). The most studied treatment was cognitive behavioral therapy (CBT; n = 22), followed by interpersonal psychotherapy (IPT; n = 13). Other interventions reviewed include other talk therapies (n = 5), collaborative care models (n = 2), complementary and alternative medicine approaches (n = 18), light therapy (n = 3), brain stimulation (n = 2), and psychopharmacological interventions (n = 13). Eleven studies focused specifically on treatment for low-income and/or minority women. Both CBT and IPT demonstrated a significant benefit over control conditions. However, findings were mixed when these interventions were examined in low-income and/or minority samples. There is some support for complementary and alternative medicine approaches (e.g., exercise). Although scarce, SSRIs demonstrated good efficacy when compared to a placebo. However, SSRIs did not outperform another active treatment condition (e.g., CBT). There is a tremendous need for more studies focused on treatment of perinatal anxiety and trauma-related disorders, as well as psychopharmacological effectiveness studies. Limitations and future directions of perinatal treatment research, particularly among low-income and/or minority populations, are discussed.

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“…The much larger observational evidence base on psychotropic drug use in pregnancy has also placed a greater emphasis on safety for the exposed child than on efficacy for the mentally unwell mother 55 . This focus on risk of harm to child is reflected in high rates of psychotropic drug discontinuation during pregnancy in women with bipolar disorder 108‐110 , exceeding discontinuation rates of the same medications for epilepsy 110 .…”

Section: Interventionsmentioning

confidence: 99%

Perinatal mental health: a review of progress and challenges

2020

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Perinatal mental health has become a significant focus of interest in recent years, with investment in new specialist mental health services in some high‐income countries, and inpatient psychiatric mother and baby units in diverse settings. In this paper, we summarize and critically examine the epidemiology and impact of perinatal mental disorders, including emerging evidence of an increase of their prevalence in young pregnant women. Perinatal mental disorders are among the commonest morbidities of pregnancy, and make an important contribution to maternal mortality, as well as to adverse neonatal, infant and child outcomes. We then review the current evidence base on interventions, including individual level and public health ones, as well as service delivery models. Randomized controlled trials provide evidence on the effectiveness of psychological and psychosocial interventions at the individual level, though it is not yet clear which women with perinatal mental disorders also need additional support for parenting. The evidence base on psychotropic use in pregnancy is almost exclusively observational. There is little research on the full range of perinatal mental disorders, on how to improve access to treatment for women with psychosocial difficulties, and on the effectiveness of different service delivery models. We conclude with research and clinical implications, which, we argue, highlight the need for an extension of generic psychiatric services to include preconception care, and further investment into public health interventions, in addition to perinatal mental health services, potentially for women and men, to reduce maternal and child morbidity and mortality.

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Psychotropic Drug Use before, during, and after Pregnancy: A Population-Based Study in a Canadian Cohort (2001-2013)

Abstract: The use of psychotropic agents increased over 12 years. The safety of continuing versus discontinuing these agents during pregnancy remains uncertain, but we observed a decrease in psychotropic drug use during the pregnancy period.

Cited by 30 publications

References 22 publications

An algorithm to identify pregnancies in BIFAP Primary Care database in Spain: Results from a cohort of 155 419 pregnancies

An algorithm to identify pregnancies in BIFAP Primary Care database in Spain: Results from a cohort of 155 419 pregnancies

Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: A systematic review

Perinatal mental health: a review of progress and challenges

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