(243) Antidepressant Use Patterns During Pregnancy and Birth Outcomes Among Pre-Conception Antidepressant Users

Publication Number: 574

Background: Significant gaps remain in our understanding of the relationship between prenatal antidepressant exposure and birth outcomes.

Objectives: To examine the associations of antidepressant use patterns with preterm birth and NICU admission, among preconception antidepressant users.

Methods: We conducted a non-concurrent cohort study of live births in a Kaiser Permanente Northern California facility between September 2014 and September 2017 to women with an antidepressant fill that overlapped with the 8th gestational week. Data was extracted from electronic health records. Antidepressant use was categorized into 3 patterns: continued use; discontinued use; stopped and reinitiated. Modified Poisson regression was conducted to evaluate continuous use (compared to discontinued use or stopped and reinitiated use) with preterm birth and NICU admission, after adjusting for depression severity and confounders, including medical comorbidities. Sensitivity analyses adjusted for psychotherapy during pregnancy, and conceptualized the exposure as a medication possession ratio (MPR; across pregnancy and for each trimester) and by FDA drug classes.

Results: Of 3637 pregnancies, 33% (n=1204) continued antidepressant use, 47% (n=1721) discontinued, and 20% (n=712) stopped and reinitiated during pregnancy. Discontinuation occurred most during the late first or early second trimester, reinitiation was higher in the late second or early third trimester. Among the continuation group, 16% (n=193) of deliveries were preterm and 15% (n=178) had a NICU admission. 8-9% of pregnancies with antidepressant discontinuation or stopping and reinitiation had a preterm birth or NICU admission. After confounder adjustment, antidepressant continuation was associated with an 86% higher risk of preterm birth (aRR: 1.86, 95%CI: 1.53, 2.27) and 76% higher risk of NICU admission (aRR: 1.76, 95% CI: 1.42, 2.19) compared to discontinuation, and 66% higher risk of preterm birth (aRR: 1.66, 95%CI: 1.27, 2.18) and 85% higher risk of NICU admission (aRR: 1.85, 95%CI: 1.39, 2.46) compared to stopping and reinitiation. Sensitivity analyses using MPRs demonstrated similar results with stronger associations in the 2nd and 3rd trimesters.

Conclusions: Antidepressant continuation during pregnancy was associated with a higher risk of preterm birth and NICU admission. A dose-response relationship was also noted, suggesting greater cumulative exposure to antidepressants is associated with greater risk of preterm birth and NICU admission. Findings suggest counseling women with preconception antidepressant use regarding potential risks and monitoring women with antidepressant continuation during pregnancy are warranted.