(200) Postpartum Episode of Eating, Mood, or Anxiety Disorder in Women with Eating Disorders Who Continue or Discontinue Antidepressant Treatment in Pregnancy

Publication Number: 531

Background: Understanding the preventative potential of antidepressant treatment in pregnancy on relapse or worsening of the eating disorders (EDs) after childbirth is an important clinical question, as continuation of an ED and/or onset of other mood or anxiety dimensions postpartum can negatively affect mother-child health and bonding, and the woman’s ability to take care of the child

Objectives: To determine the association between antidepressant continuation in pregnancy and postpartum ED episode. Because EDs often co-exist with depression and anxiety, we also examined the association with postpartum episodes of mood/anxiety disorders.

Methods: Using data from the Danish national health registries, we identified 3547 singleton, live-birth pregnancies in 1998-2015 among women with ED diagnosed in the four years before pregnancy. Pregnancies were classified as having (i) continued antidepressant use (n=564), i.e., with antidepressant fills two years before and during pregnancy; (ii) discontinued antidepressant use (n=778), i.e., with antidepressant fills only before but not during pregnancy; (iii) unexposed (n=2 137), i.e., with no antidepressant fills neither before nor during pregnancy. We fit unadjusted and weighted Cox proportional hazard models using the inverse probability of treatment weighting to estimate hazard ratios (HRs) and 95% Confidence Intervals (CI).

Results: The risk for a postpartum ED episode was lower with antidepressant continuation relative to discontinuation (weighted HR: 0.89, 95% CI: 0.52, 1.52), and the point estimate decreased further with two or more antidepressant fills (weighted HR: 0.74, 95% CI: 0.37-1.48), albeit the 95% CIs crossed the null. There were no major differences in results by ED subtype. When the hazard was averaged over the study follow-up, pregnancies with continued antidepressant had a 27% increased risk of having a postpartum episode of mood/anxiety disorders compared to the discontinued group, but the 95% included the null.

Conclusions: Among women with ED before pregnancy, continued antidepressant treatment during pregnancy was not preventively associated with a substantial, reduced risk for an ED or mood/anxiety episode in the postpartum year. The decision-making about antidepressant treatment in pregnancy should always weigh the benefit of the medication to woman’s mental health during the entire perinatal period against potential harm to the unborn child.