Research
Obstetrics
Increasing use of antidepressants in pregnancy

https://doi.org/10.1016/j.ajog.2007.01.033Get rights and content

Objective

The purpose of this study was to quantify the rate of exposures to antidepressants during pregnancy in a large cohort of women.

Study Design

This was a retrospective cohort study of 105,335 pregnancies among women enrolled in Tennessee Medicaid from 1999-2003. Pregnancies were classified according to antidepressant exposures during pregnancy using previously validated computerized pharmacy records linked with birth certificates.

Results

During the study period, 8.7% of women giving birth had exposure to any antidepressant; 6.2% had exposure to a selective serotonin reuptake inhibitor. Maternal age > 25 years (P < .0001), white race (P < .0001), and education > 12 years (P = .008) were significant predictors of antidepressant exposure. The proportion of pregnancies with antidepressant use increased from 5.7% of pregnancies in 1999 to 13.4% of pregnancies in 2003 (p<.0001). The increase was mostly accounted for by increases in selective serotonin reuptake inhibitor exposures.

Conclusion

There is an urgent need for further studies that better quantify the fetal consequences of exposure to antidepressants.

Section snippets

Materials and Methods

The study was conducted using data from TennCare, Tennessee’s expanded Medicaid program, for which computerized records of filled prescriptions have been shown to be an accurate source of medication data and have high concordance with patient self-report of medication use.9, 10, 11 Links to vital records (birth, death, and fetal death certificates) files and medical records permit identification of pregnant women, including estimated conception dates.9, 12, 13, 14

Vital records and TennCare

Results

During the study period, the number of mothers who qualified for the cohort each year ranged from 19,421 to 21,997. The mean age (range of mean age 23.2 ± 5.3 years to 23.3 ± 5.2 years) and proportions of mothers who were prima gravida (proportion for each year ranged from 24.3-25.5%), were black race (28.2-40.5%), had greater than 12 years of education (14.1-15.1%), resided in an urban county (43.0-45.5%), and who resided in neighbors with the lowest income (23.6-26.8%) did not change

Comment

In this study of antidepressant use during pregnancy in a large cohort of women enrolled in the TennCare program, we found a marked temporal trend of increasing use during the 5-year period 1999 through 2003. By 2003, more than 13% of pregnancies had an antidepressant exposure. SSRIs accounted for most of the increase in antidepressant exposures, with use of these drugs by more than 10% of pregnant women by 2003. Use of other antidepressants during pregnancy increased at a more moderate rate

Acknowledgments

We gratefully acknowledge the Tennessee Department of Health and the TennCare Bureau, who provided the data for the study.

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    Cite this article as: Cooper WO, Willy ME, Pont SJ, et al. Increasing use of antidepressants in pregnancy. Am J Obstet Gynecol 2007;196;544.e1-544.e5.

    Funding to conduct the study was provided by the Food and Drug Administration (contract #HHSF223200510010C) and the Centers for Education and Research on Therapeutics, Agency for Healthcare Research and Quality (HS-0384).

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