Antipsychotic Medication Use Among Publicly Insured Pregnant Women in the United States

Park, Yoonyoung; Huybrechts, Krista F.; Cohen, Jacqueline M.; Bateman, Brian T.; Desai, Rishi; Patorno, Elisabetta; Mogun, Helen; Cohen, Lee S.; Hernández–Dı́az, Sonia

doi:10.1176/appi.ps.201600408

Cited by 51 publications

(43 citation statements)

References 40 publications

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“…We adjusted for a high number of potential confounders obtained from the registers and included a comparison group of women using F-GAs during pregnancy, controlling to some extent for maternal illness. The prevalence of antipsychotic drug use and several of the examined outcomes in our study were comparable with those in other countries [1,6,7,12], suggesting that the results are generalizable to other populations. Further, data in the drug prescription register is virtually complete [20] and as antipsychotics are reimbursed, it is likely that all purchases are included in our data.…”

Section: Discussionsupporting

confidence: 82%

“…Apart from genetically determined characteristics, maternal diabetes and high prepregnancy BMI are major risk factors for being born LGA. Previous research has shown conflicting results: increased risk of gestational diabetes was not observed in studies based on prospective interviews [28], electronic health records [12], and health administrative databases [13], while a recent study based on Medicaid data observed an increased risk of gestational diabetes in women using olanzapine or quetiapine [1]. Two previous studies with prospectively collected exposure data reported an increased risk of LGA associated with S-GA use [8,9], but the numbers of exposed were too small for meaningful analysis.…”

Section: Discussionmentioning

confidence: 99%

“…This tendency is evident not only on population level but also within the pregnant population. In the USA, the prevalence of use of S-GAs during pregnancy increased from 0.4 to 1.3% in 2001-2010, while the use of first-generation antipsychotics (F-GAs) remained stable at around 0.1% [1]. The increased use of S-GAs may be related to the argued, but not uniformly proven, better tolerability or a more favorable side-effect profile when compared with that of F-GAs [2].…”

Section: Introductionmentioning

confidence: 99%

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Second-generation antipsychotics and pregnancy complications

Ellfolk

Leinonen

Gissler

et al. 2019

Eur J Clin Pharmacol

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Purpose To study if second-generation antipsychotic (S-GA) use during pregnancy is associated with an increased risk of pregnancy and neonatal complications. Methods A population-based birth cohort study using national register data extracted from the "Drugs and Pregnancy" database in Finland, years 1996-2016. The sampling frame included 1,181,090 pregnant women and their singleton births. Women were categorized into three groups: exposed to S-GAs during pregnancy (n = 4225), exposed to first-generation antipsychotics (F-GAs) during pregnancy (n = 1576), and unexposed (no purchases of S-GAs or F-GAs during pregnancy, n = 21,125). Pregnancy outcomes in S-GA users were compared with those in the two comparison groups using multiple logistic regression models. Results Comparing S-GA users with unexposed ones, the risk was increased for gestational diabetes (adjusted odds ratio, OR 1.43; 95% CI 1.25-1.65), cesarean section (OR 1.35; 95% CI 1.18-1.53), being born large for gestational age (LGA) (OR 1.57; 95% CI 1.14-2.16), and preterm birth (OR 1.29; 95% CI 1.03-1.62). The risk for these outcomes increased further with continuous S-GA use. Infants in the S-GA group were also more likely to suffer from neonatal complications. Comparing S-GA users with the F-GA group, the risk of cesarean section and LGAwas higher (OR 1.25, 95% CI 1.03-1.51; and OR 1.89, 95% CI 1.20-2.99, respectively). Neonatal complications did not differ between the S-GA and F-GA groups. Conclusions Prenatal exposure to S-GAs is associated with an increased risk of pregnancy complications related to impaired glucose metabolism. Neonatal problems are common and occur similarly in S-GA and F-GA users.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Second-generation antipsychotics and pregnancy complications

Ellfolk

Leinonen

Gissler

et al. 2019

Eur J Clin Pharmacol

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“…For treatment resistant depression, second generation antipsychotics and mood stabilizers have been used as augmenting agents or as a replacement to typical agents such as anti-depressants. To this end, the use of antipsychotics, particularly second generation antipsychotics, during the perinatal period has increased dramatically both in the United States and worldwide, potentially due to the expansion of such off label uses (Park et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: A systematic review

Nillni

Mehralizade

Mayer

et al. 2018

Clinical Psychology Review

144

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Women with psychiatric disorders during pregnancy and the postpartum period (i.e., perinatal period) are at increased risk for adverse maternal and child outcomes. Effective treatment of psychiatric disorders during the perinatal period is imperative. This review summarizes the outcomes of 78 studies focused on the treatment of depression, anxiety, and trauma-related disorders during the perinatal period. The majority of studies focused on perinatal depression (n = 73). Of the five studies focused on anxiety or trauma-related disorders, only one was a randomized controlled trial (RCT). The most studied treatment was cognitive behavioral therapy (CBT; n = 22), followed by interpersonal psychotherapy (IPT; n = 13). Other interventions reviewed include other talk therapies (n = 5), collaborative care models (n = 2), complementary and alternative medicine approaches (n = 18), light therapy (n = 3), brain stimulation (n = 2), and psychopharmacological interventions (n = 13). Eleven studies focused specifically on treatment for low-income and/or minority women. Both CBT and IPT demonstrated a significant benefit over control conditions. However, findings were mixed when these interventions were examined in low-income and/or minority samples. There is some support for complementary and alternative medicine approaches (e.g., exercise). Although scarce, SSRIs demonstrated good efficacy when compared to a placebo. However, SSRIs did not outperform another active treatment condition (e.g., CBT). There is a tremendous need for more studies focused on treatment of perinatal anxiety and trauma-related disorders, as well as psychopharmacological effectiveness studies. Limitations and future directions of perinatal treatment research, particularly among low-income and/or minority populations, are discussed.

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“…In such cases, the drugs may be frequently discontinued in preparation for a planned pregnancy or soon after pregnancy recognition. Utilization studies have shown that psychotropic drugs are frequently discontinued in pregnancy . The extent to which this occurs early in pregnancy (initial weeks) may vary by drug class and by individual drug.…”

Section: Introductionmentioning

confidence: 99%

Interrupted time series analysis to assess changes in prescription filling around conception and implications for exposure misclassification

Cohen

Selmer

Furu

et al. 2020

Pharmacoepidemiology and Drug

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Purpose Medication exposures in pregnancy are often defined by one or more prescription fills. Harmful effects could be underestimated if rapid discontinuation of use after pregnancy recognition is common. We used conception, a critical biological period, as an intervention in a novel application of interrupted time series analysis (ITSA). Methods Among 645 049 pregnancies from the Medical Birth Registry (2005‐2015) linked to the Norwegian Prescription Database, we modeled the total number of prescription fills in the 12 weeks before and after estimated conception date with ITSA. We examined psychostimulants, antidepressants, antipsychotics, and antiepileptics (AEDs; separated by use for epilepsy or other indications). We used relative measures (%) to compare model coefficients. We also compared number of pregnancies defined as exposed when the earliest fill considered was 30 days before the last menstrual period (LMP −30 days), LMP, or estimated conception date (LMP +14 days). Results We observed a sudden decline in prescription fills from 2 weeks after conception and decreasing fills thereafter for psychostimulants, antidepressants, AEDs for other indications, and antipsychotics excluding incident users. Fills for AEDs for epilepsy did not fall after conception. Only 77% of pregnancies with fills for psychostimulants from LMP and 58% with fills from LMP −30 days had fills from conception. Similar figures for AEDs for epilepsy were 99% and 96%. Conclusions This application shows that ITSA can help researchers understand rapid changes in patient behavior around conception that have consequences for exposure misclassification in pregnancy drug safety studies. ITSA results can help pharmacoepidemiologists guide study exposure definitions.

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Antipsychotic Medication Use Among Publicly Insured Pregnant Women in the United States

Cited by 51 publications

References 40 publications

Second-generation antipsychotics and pregnancy complications

Second-generation antipsychotics and pregnancy complications

Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: A systematic review

Interrupted time series analysis to assess changes in prescription filling around conception and implications for exposure misclassification

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