Prevalence of Antidepressant Use during Pregnancy in Denmark, a Nation-Wide Cohort Study

Abstract

AimThe aim of this study was to assess the prevalence and patterns of exposure to antidepressants before, during and after pregnancy in a cohort including all pregnant women in Denmark between 1997 and 2010.MethodsWe performed a retrospective cohort study including 912 322 pregnancies. Information was retrieved from the Danish Birth Registry and The Register of Medicinal Product Statistics to identify women redeeming an antidepressant prescription during pregnancy. Exposure periods were based on standard treatment doses and dispensed pack sizes.ResultsWe identified 19 740 pregnancies exposed to an antidepressant at some point during pregnancy. The rate of exposure increased from 0.2% in 1997 to 3.2% in 2010. We found that the rate of exposure was halved during the first 3 months of pregnancy. In contrast, we describe a clear increase in exposure after pregnancy among pre-delivery treatment-naïve women.ConclusionsIn spite of uncertainty concerning antidepressants’ safety during pregnancy we find a 16-fold increase in exposure rates between 1997 and 2010. The rates describe a sharp decrease in exposure during pregnancy that is probably caused by physicians’ hesitation to prescribe antidepressants and women’s fear of unwanted effects on the unborn child. More studies are needed to clarify the consequences of antidepressant discontinuation during pregnancy.

Antidepressant Use During Pregnancy and Asthma in the Offspring

“…1,2 The use of antidepressants during pregnancy has increased, from 0.2% of pregnancies in 1997 to 3.2% in 2010 in Denmark, 3 and from 2.0% in 1996 to 7.6% in 2005 in the United States. 4 Antidepressants may cross the placenta and enter the fetal circulation, 5 thus making use of antidepressants during pregnancy a public health and a clinical concern.…”

Sertraline use during pregnancy and the risk of major malformations

“…[1][2][3] Studies concerning the adverse effects of SSRI exposure during gestation on the developing fetus have indicated an increased risk of various congenital malformations, [4][5][6][7][8][9] but inconsistencies between study results remain. [10][11][12][13][14] These could potentially be explained by indication bias where the effect of the drug and the indication are correlated and not fully accounted.…”

Offspring Outcomes in Studies of Antidepressant-Treated Pregnancies Depend on the Choice of Control Group

“…[8][9][10][11] However, antidepressant use, and, more specifically, selective serotonin reuptake inhibitor (SSRI) use, has itself been associated with adverse pregnancy and neonatal outcomes such as spontaneous abortion, preterm birth, low birth weight, major congenital malformations, poor neonatal adaptation syndrome, persistent pulmonary hypertension of the newborn, and neurodevelopmental disorders in early childhood; the results, though, have not always been consistent. [12][13][14][15][16] A limitation of the studies that demonstrate significant associations (between antidepressant use and adverse outcomes) is that they are compromised by confounding, often from inaccurately measured or unmeasured or even unknown sources that cannot be adjusted for using the data that are available.…”