The international prevalence of antidepressant use before, during, and after pregnancy: A systematic review and meta-analysis of timing, type of prescriptions and geographical variability

Abstract

Background: Antidepressant use during pregnancy has increased over the last decades, while safety has been under debate. Our aim was to measure the international prevalence of antidepressant use before, during, and after pregnancy and examine timing, type of prescriptions and geographic variability. Methods: We searched Embase, Medline Ovid, Web of Science, Cochrane Central and Google Scholar from their inception until February 19, 2019. We determined pooled prevalence estimates of antidepressants before, during, and after pregnancy, as well as stratified according to substantive variables. Results: We identified 40 cohorts from 15 countries, together reporting on 14,072,251 pregnancies. Included studies had a low risk of bias, often reporting on large representative cohorts. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly used antidepressants during pregnancy, with an international prevalence estimate of 3.0% (95%CI 2.3;3.7). While Europe and Australasia had pooled prevalence estimates of 1.6% and 1.3% respectively, Northern America had a prevalence estimate of 5.5% (Q-value = 126.19; df = 2; p-value<0.01). Highest SSRI prevalence rates were found for sertraline (1.10%), followed by citalopram and fluoxetine (0.77% and 0.76% respectively) (Q-value = 121.25; df = 5; p-value<0.01). Qualitative analysis indicated an increase in antidepressant use over subsequent calendar years. Limitations: Substantial heterogeneity remained unaccounted for throughout the analyses, even after accounting for hypothetical contributors. Conclusions: This meta-analysis revealed substantial regional differences in antidepressant use around pregnancy, which could be due to variability in prescription behavior, healthcare seeking behavior and organization of healthcare. There is an urgent need for evidence on effectiveness, benefit, and harm of antidepressants during pregnancy to guide clinical practice. greatly contribute to this increase (Andrade et al., 2016;Charlton et al., 2015;Cooper et al., 2007). In the general population, antidepressants are now among the top three most commonly prescribed therapeutic drug classes in the United States (Pratt et al., 2017). Antidepressants showed the largest increase in prescriptions during pregnancy over time, compared to other drugs associated with potential harmful neonatal effects (van Gelder et al., 2014).

Factors associated with re-initiation of antidepressant treatment following discontinuation during pregnancy: a register-based cohort study

“…Previous studies show around 40–50% of women discontinue antidepressants, either shortly before or early in pregnancy (Charlton et al 2015 ; Molenaar et al 2020a ), though there are large geographical differences in the prevalence of discontinuation or prescription rates (Charlton et al 2015 ; Molenaar et al 2020b ). In the present study 3 in 4 women discontinued antidepressants during pregnancy.…”

Association between Antidepressant Treatment during Pregnancy and Postpartum Self-Harm Ideation in Women with Psychiatric Disorders: A Cross-Sectional, Multinational Study

“…Under the assumption that data were missing at random, we imputed incomplete data via multiple imputation with chained equation (five replications) [43]. 3 Women having the first language different from the official main language in the country of residency. 4 Indicates alcohol use after awareness of pregnancy.…”

“…During pregnancy, between 2% and 6% of women take antidepressants to treat perinatal psychiatric disorders, mainly depression and anxiety, and their use appears to be trending upward since the 1990s [1][2][3]. Women with an antenatal mental illness are at high risk for sustained illness during the perinatal period and/or for a relapse up to one year postpartum [4,5].…”

Affective disorders: A question of continuing treatment during pregnancy (Review)

“…Narrowing negative outcomes (cardiovascular malformation, pulmonary hypertension, sub-optimal neurobehavioral function, premature birth, low weight on delivery) to antidepressants alone is difficult; considering that genetics and other hereditary issues such as the underlying maternal mental illness as well as lifestyle can contribute to deformities. Over time the puerperal use of antidepressants has increased, although opinions are yet divided (8,9). The challenges faced by the health care providers are to identify an optimal treatment plan considering associated endocrine particularities or work burnout syndrome (10), when research on the topic is still scarce.…”

“…SSRIs are first-line pharmaceuticals in treating depression as well as the favored antidepressants during pregnancy, with an international prevalence estimate of 3.0% (95% CI, 2.3; 3.7) because of their safety profile. Moreover, among SSRIs the preferred substance was sertraline followed by citalopram (8).…”