A patient decision aid for antidepressant use in pregnancy: Pilot randomized controlled trial

Vigod, Simone N.; Hussain-Shamsy, Neesha; Stewart, Donna E.; Grigoriadis, Sophie; Metcalfe, Kelly; Oberlander, Tim F.; Schram, Carrie; Taylor, Valerie H.; Dennis, Cindy‐Lee

doi:10.1016/j.jad.2019.01.051

Cited by 25 publications

(37 citation statements)

References 25 publications

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“…There is some evidence that women often over‐estimate medication (including antidepressant) teratogenic risks 116 , and that evidence‐based counselling can enable them to restart medication where needed 117 . Two recent pilot trials of a decision aid to help women decide whether or not to use antidepressants in pregnancy have reported preliminary evidence of efficacy 118,119 .…”

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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Section: Interventionsmentioning

confidence: 99%

Perinatal mental health: a review of progress and challenges

2020

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“…Our findings underscore important target areas for health interventions for reproductive-aged autistic women. For instance, while decision aids for psychotropic medication use in pregnancy have been designed for women with depression in the general population who are planning a pregnancy (Vigod et al, 2019), we do not know whether these tools are beneficial for autistic women. It is essential to tailor health interventions to the specific needs of different populations (Mitra et al, 2015; Ruhl & Moran, 2008) and it is likely that modifications to existing interventions would be needed to adequately address the unique needs of autistic women (e.g.…”

Section: Discussionmentioning

confidence: 99%

Health characteristics of reproductive-aged autistic women in Ontario: A population-based, cross-sectional study

Tint

Brown

Chen³

et al. 2021

Autism

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While an increasing number of girls and women are being identified with autism, we know little about the health of reproductive-aged autistic women. Our objectives were to (1) describe health characteristics of reproductive-aged autistic women who could potentially become pregnant and (2) compare these characteristics with those of non-autistic women. We conducted a population-based cross-sectional study using 2017–2018 administrative health data from Ontario, Canada. A total of 6,870 fifteen- to 44-year-old autistic women were identified and compared with 2,686,160 non-autistic women. Variables of interest included social determinants of health (neighborhood income, residential instability, material deprivation, rurality), health (co-occurring medical and psychiatric conditions, use of potentially teratogenic medications, history of assault), and health care factors (continuity of primary care). Overall, reproductive-aged autistic women had poorer health compared with non-autistic women, including increased rates of material deprivation, chronic medical conditions, psychiatric conditions, use of potentially teratogenic medications, and history of assault. These findings highlight the need for health interventions tailored to the needs of reproductive-aged autistic women. Lay abstract While an increasing number of girls and women are being identified with autism, we know little about reproductive-aged autistic women’s health. This study used administrative data from Ontario, Canada, to compare the health of reproductive-aged autistic women with non-autistic women. Overall, reproductive-aged autistic women had poorer health compared with non-autistic women, including increased rates of material deprivation, chronic medical conditions, psychiatric conditions, history of assault, and use of potentially teratogenic medications (i.e. drugs that can be harmful to the development of an embryo or fetus). These findings suggest that there is a need for health interventions tailored to the needs of reproductive-aged autistic women.

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“…We established patient need for a decision aid on OCS use during pregnancy that health care providers can discuss with their patients, and, following the IPDAS checklist, we plan to elicit clinician perspectives next 36 . There are few published patient decision aids for medications in pregnancy 35,54 . Given the support expressed for patient‐centered handouts about OCS use and for shared decision making regarding medications in pregnancy in general, development of decision aids on using other medications during pregnancy may be crucial for addressing unmet patient needs and provider barriers to provide efficient counseling.…”

Section: Discussionmentioning

confidence: 99%

“…They can facilitate shared decision making, a process by which patients and providers reach a health care decision together 32‐34 . Moreover, shared decision aids can disseminate evidence‐based information, reduce patients' decisional conflict, and improve patient knowledge 32,34,35 . The International Patient Decision Aids Standards (IPDAS) checklist includes an assessment of patient needs as a quality criterion for developing a decision aids, 36 and qualitative research with patients can enhance decision aids 37,38 .…”

Section: Introductionmentioning

confidence: 99%

“I know my body better than you:” patient focus groups to inform a decision aid on oral corticosteroid use during pregnancy

Palmsten

Bredesen

Kumar

et al. 2020

Pharmacoepidemiology and Drug

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Purpose There is unmet need for decision support regarding medication use during pregnancy. We aimed to inform the development of a decision aid on oral corticosteroid (OCS) use during pregnancy through focus groups. Methods We invited patients from one health system who had a recent live birth and a condition for which OCSs may be prescribed (ie, asthma or other autoimmune disease) to participate in focus groups. We conducted conventional qualitative content analysis of verbatim transcripts of the focus groups using inductive coding. Results There were 30 participants across five focus groups from May to June 2019. Women endorsed the need for patient‐provider discussions about OCS use during pregnancy in which the provider shares risks and benefits and the patient makes her decision. Furthermore, women generally expressed support for patient‐centered handouts about OCS use during pregnancy that the provider discusses with the patient. When considering whether to take OCSs in pregnancy, women had concerns about: the medication's impact on their baby (eg, miscarriage, birth defects, long‐term effects), themselves (eg, effects on mood, sleep, weight gain), pregnancy complications (eg, preterm birth, increased blood pressure), and lactation. Women wanted information on OCSs (eg, indications, length of treatment, and cost), alternative treatments, and risks of not taking OCSs. Conclusions We established patient need for a decision aid on OCS use during pregnancy that providers can discuss with patients. To address patient concerns, the aid should at a minimum describe the medication's impact on baby, including long‐term effects, maternal health, pregnancy complications, and lactation.

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A patient decision aid for antidepressant use in pregnancy: Pilot randomized controlled trial

Cited by 25 publications

References 25 publications

Perinatal mental health: a review of progress and challenges

Perinatal mental health: a review of progress and challenges

Health characteristics of reproductive-aged autistic women in Ontario: A population-based, cross-sectional study

“I know my body better than you:” patient focus groups to inform a decision aid on oral corticosteroid use during pregnancy

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