(214) Decisional Conflicts About Antidepressant Treatment in Pregnant Women in Norway

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 545

Presenting Author(s)

Angela Lupattelli, MSc
– Researcher, University of Oslo, University of Oslo, Oslo, Oslo, Norway

Co-Author(s)

Lana Jalal Shabat
– Student, Department of Pharmacy, University of Oslo, Norway
Fatima Tauqeer
– PhD student/ Pharmacist, University of Oslo, Oslo, Oslo, Norway

Background: The decision-making about antidepressant treatment in pregnancy is complex. Understanding the extent of and predictors of high decisional conflict about this treatment in pregnant women is crucial for clinical decisions and counselling.

Objectives: To examine the extent of decisional conflict in a sample of women considering antidepressant medication use in pregnancy in Norway, as well as maternal factors associated with difficulty in this decision-making.

Methods:

Design: Cross-sectional, web-based study.
Setting: Nationwide in Norway, June 2019-June 2020.
Participants: Women of age 18-55 years who were pregnant and had been offered antidepressants in the last 5 years.
Exposure: Maternal sociodemographic, health-related factors, partner and doctor support, and perceived benefit-risk differential for antidepressants in pregnancy.
Main outcome measure: Decisional Conflict Scale (DCS) with range from 0 (=no decisional conflict) to 100 (extremely high decisional conflict). The DCS includes 16 items measuring 5 dimensions of decision making. We defined the decisional conflict as low (DCS < 25), moderate (DCS 25-37.5) or high (DCS >37.5).
Statistical analysis: Linear regression was used to identify factors associated with the DCS total score.

Results: 236 pregnant women participated, whereof 61 (25.8%) had low, 63 (26.7%) moderate, and 112 (47.5%) high decisional conflict. Non-users of antidepressants had greater DCS score on the “Informed” and “Uncertainty” sub-scales than antidepressant-users both before and during pregnancy. Being single, job-seeker, or smoking daily were associated with lower DCS (range betas: -10.7, -16.8), while having mother tongue other than Norwegian was associated with greater DCS (beta: 9.3). Decisional conflict was about 10 points lower in women at the second or third trimester of pregnancy, relative to those in the first trimester. The perceived benefit-risk differential of antidepressants in pregnancy was negatively associated with greater decisional conflict (beta: -0.8 95% CI: -1.5, -0.1). Low support by the partner or doctor in relation to antidepressant treatment was associated with greater decision-making difficulty.

Conclusions: Many pregnant women considering antidepressant treatment experience high decisional conflicts. The difficulty in the decision-making seems to be driven by women's uncertainties about this treatment and by feeling poorly informed. Individual perception of the antidepressant benefit-risk differential, timing of pregnancy, and specific unfavorable characteristics are important factors to consider for targeted counselling of pregnant women in need of antidepressant treatment.