Does the Pattern of Prenatal Antidepressant Use Alter the Risks for Adverse Neonatal Outcomes?
BACKGROUND AND PURPOSE:
The association between antidepressant use and adverse neonatal outcomes is unclear
Inconsistency may be a result of differing usage patterns, e.g. between low to moderate to high use
Bandoli et al. (Pediatrics, 2020) attempted to address this limitation of previous studies by estimating the risk of neonatal outcomes based on the pattern of antidepressant use (accounting for timing of exposure, dose, and duration)
The authors identified antidepressant claims with coverage between DLMP and 35 weeks gestation
The lowest trajectory of use was designated as the primary reference group
Depression and anxiety with no antidepressant claims served as secondary reference groups
Major cardiac malformations
Newborn respiratory distress
Total 226,932 singleton deliveries
Exposed to an antidepressant: 6.6%
Sertraline (32.4%) | Citalopram, fluoxetine, escitalopram, and bupropion (all at 13% of antidepressant fills)
Low use (∼10 mg/day) with first-trimester reduction or discontinuation
Low sustained use (∼20 mg/day)
Moderate use (∼40 mg/day) with first-trimester reduction or discontinuation
Moderate sustained use (∼40 mg/day)
High sustained use (∼75 mg/day)
The moderate sustained trajectory increased the risk of major cardiac malformations
However, there was no difference when compared with depression or anxiety reference groups
Moderate and high sustained trajectories were associated with an increased risk of preterm birth
Moderate sustained: adjusted risk ratio (RR) 1.31 (95% CI, 1.16 to 1.49)
High sustained: adjusted RR 1.78 (95% CI, 1.48 to 2.14)
All 4 trajectories increased the risk of neonatal respiratory distress in a dose-response fashion
adjusted RRs 1.36 (95% CI, 1.20 to 1.50) to 2.23 (95% CI, 1.83 to 2.77)
Limitations include lack of data on whether patients who filled prescriptions actually took their medications | Commercial insurance data may not be generalizable to those with limited insurance | Confounding due to smoking, alcohol or BMI possible as this data is not well captured
The findings of this study support using the lowest effective dose of antidepressants in pregnancy possible
The authors also highlight that the risk of neonatal respiratory distress was higher with all trajectories of antidepressant use, and the risk of preterm birth was higher with moderate or high sustained use
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan