Antidepressant Fill and Dose Trajectories in Pregnant Women with Depression and/or Anxiety: A Norwegian Registry Linkage Study

• Published in: Clinical epidemiology 2022-01, Vol.14, p.1439-1451
• Main Authors: Trinh, Nhung T H, Nordeng, Hedvig M E, Bandoli, Gretchen, Palmsten, Kristin, Eberhard-Gran, Malin, Lupattelli, Angela
• Format: Article
• Language: English
• Subjects: Analysis; antidepressant fill trajectories; Antidepressants; Anxiety; Clinical medicine; Depression, Mental; depression/anxiety; Drug dosages; Drug use; drug utilization; Epidemiology; Linked Data; longitudinal k-means trajectory modelling; Mental depression; Mental disorders; Mental health; Obstetrics; Original Research; Packaging; Patients; Pregnancy; Pregnant women; Prescription drugs; Primary care; Psychological aspects; Psychotropic drugs; Reimbursement; Ultrasonic imaging; Womens health
• ISSN: 1179-1349; 1179-1349
• DOI: 10.2147/CLEP.S379370

Few studies investigated longitudinal antidepressant exposure during pregnancy and included dosage in the assessment. We conducted a nationwide, registry-linkage study in Norway using data on antidepressant prescription fills in pregnancies lasting ≥32 weeks in women with a delivery between 2009 and 2018 who had a depression/anxiety diagnosis and antidepressant fills prior to pregnancy. Information on antidepressant exposure by week (measured by filled prescriptions) and prescribed average daily dose was used in longitudinal k-means trajectory modelling for a 108-week time window from six months prior to pregnancy to one year after delivery. Factors associated with trajectory group membership were examined using multinomial logistic regression models. We included 8,460 pregnancies in 8,092 women. Four antidepressant fill trajectories were identified based on filled antidepressant prescriptions: two distinct discontinuing patterns, one at around the start of pregnancy (30.4%) and one around the end of pregnancy (33.8%); one continuing pattern (20.6%); and one interrupting pattern (15.2%). Using average usual daily dose, we identified low dose discontinuing (60.3%), medium dose reducing (20.6%) and high dose continuing (15.2%) patterns. The multinomial logistic regressions showed that the fill trajectory group membership was strongly associated with: antidepressant type and dose prior to pregnancy and co-medication prior to pregnancy, maternal age, marital status, parity, previous pregnancy loss, and pregnancy planning. Longitudinal trajectory modelling revealed distinct antidepressant fill and dosage patterns in the period around pregnancy. Knowledge about factors associated with utilization trajectories might be useful for health-care personnel counselling women about antidepressant use in pregnancy.