National trends in antidepressant medication treatment among publicly insured pregnant women

Abstract

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 ≥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.

Figure 1. Assembly of the study cohort

DOB: Date Of Birth

Figure 2. Regional variation in the proportion of women with a depression diagnosis (Panel A) and antidepressant medication use (Panel B) in a cohort of 1,106,757 Medicaid-eligible pregnant women, 2000–2007

Arizona, Michigan, Montana and Connecticut (white) are not represented in the cohort

Figure 3. Changes in antidepressant medication use during pregnancy in a cohort of 1,106,757 Medicaid-eligible pregnant women, 2000–2007

The black line shows the number of women, among those exposed to antidepressants at the time of the LMP, who were continuously exposed throughout different pregnancy stages. The grey bars show the cumulative number of women, among those not exposed at the time of the LMP, who had some exposure to antidepressants during pregnancy.

Figure 4. Impact of FDA Advisory Warnings on antidepressant medication use any time during pregnancy in a cohort of 1,106,757 Medicaid-eligible pregnant women, 2000–2007

SSRI: Baseline trend: 1.27 (SE: 0.04, p<0.0001)); trend change after Paroxetine & Suicidality warning: −1.76 (SE: 0.06, p<0.0001) Paroxetine: Baseline trend: 0.27 (SE: 0.01, p<0.0001)); trend change after Paroxetine & Suicidality warning: −0.66 (SE: 0.02, p<0.0001)