National trends in antidepressant medication treatment among publicly insured pregnant women

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• 作者：Krista F. Huybrechts ; M.S. ; Ph.D.^a ; ^{khuybrechts@partners.org} ; Kristin Palmsten ; M.S.^b ; Helen Mogun ; M.S.^a ; Mary Kowal ; B.A.^a ; Jerry Avorn ; M.D.^a ; Soko Setoguchi-Iwata ; M.D. ; Dr.PH.^c ; Sonia Herná ; ndez-Dí ; az ; M.D. ; Dr.PH.^b
• 关键词：Antidepressants ; Medicaid ; National cohort ; Patterns of medication use ; Pregnancy
• 刊名：General Hospital Psychiatry
• 出版年：2013
• 出版时间：May-June, 2013
• 年：2013
• 卷：35
• 期：3
• 页码：265-271
• 全文大小：471 K

文摘

Objective

The risk of depression in women is greatest at childbearing age. We sought to examine and explain national trends in antidepressant use in pregnant women.

Methods

This was a cohort study including pregnant women aged 12-55 who were enrolled in Medicaid during 2000-2007. We examined the proportion of women taking antidepressants during pregnancy by patient characteristics (descriptive), by region (mixed-effects model) and over time (interrupted time series).

Results

We identified 1,106,757 pregnancies in 47 states; mean age was 23 years, and 60 % were nonwhite. Nearly 1 in 12 used an antidepressant during pregnancy. Use was higher for older (11.2 % for age ¡Ý 30 vs. 7.6 % for < 30) and white (14.4 % vs. 4.0 % for nonwhite) women. There was a four- to fivefold difference in rate of antidepressant use among states. Of the 5.3 % of women taking antidepressants at conception, 33 % and 17 % were still on treatment 90 and 180 days, respectively, into pregnancy; an additional 4 % began use during pregnancy. Labeled pregnancy-related health advisories did not appear to affect antidepressant use.

Conclusions

Antidepressant use during pregnancy remains high in this population; treatment patterns vary substantially by patient characteristics and region. Comparative safety and effectiveness data to help inform treatment choices are needed in this setting.