(61) Antidepressants and Antipsychotics Before and During Pregnancy in the Netherlands

Publication Number: 1106

Background: Antidepressants (AD) and antipsychotics (AP) are frequently prescribed to women at fertile age. Although knowledge about their teratogenicity is limited, benefits of continuation or initiation of treatment during pregnancy could outweigh the potential risks for the unborn child. It is therefore important to monitor such treatment patterns before and during pregnancy in the population.

Objectives: To describe AD and AP rates of prescriptions before and during pregnancy in the Netherlands.

Methods: We conducted a retrospective drug prescription study using the pregnancy subset of the University Groningen IADB.nl community pharmacy database. The study population included all singleton pregnancies with a delivery date anywhere between Jan 1st, 2000 and Dec 31st, 2019. Drug prescription rates per 1,000 pregnancies of AD or AP were assessed from 6 months before the theoretical conception date until the child’s birthdate. Prescription rates for different exposure windows were compared between decade 1 (2000-2009) and decade 2 (2010-2019) using the X2 test (p < 0.05). A top-3 of the most prescribed AD or AP drugs during pregnancy was based on a total number of continued and initiated treatments.

Results: The total AD and AP rates increased from 44.7 and 4.2 in decade 1 to 59.9 and 9.2 per 1,000 pregnancies in decade 2 (both trends p< 0.05), respectively.
Continuation rates of AD and AP prescriptions during pregnancy showed a significant increase per 1,000 pregnancies in decade 2 compared to decade 1 for antidepressants (17.7 to 31.2) and antipsychotics (1.3 to 4.0). A significant increase in initiation rate was observed for AD only (5.2 to 9.4). AD discontinuation rates decreased from 21.8 to 19.0 whereas such rates for AP increased from 1.4 to 2.9 per 1,000 pregnancies.
Top-3 of AD during pregnancy were paroxetine, fluoxetine, and amitriptyline (decade 1) and citalopram, paroxetine, and sertraline (decade 2). For AP this was haloperidol, quetiapine, and risperidone (decade 1) and quetiapine, haloperidol, and olanzapine (decade 2).

Conclusions: The continuation and initiation of AD during pregnancy increased significantly over the past two decades. AP during pregnancy also increased, mainly due to increased continuation rates. The most frequently prescribed AD during pregnancy in both decades were SSRIs. Regarding AP, it changed from typical (decade 1) to atypical APs (decade 2).