OP1-5 - Preventative association of antidepressant treatment in pregnant women with eating disorders on antenatal mental outcomes- results from the Norwegian Mother, Father, and Child Cohort Study

Preventative association of antidepressant treatment in pregnant women with eating disorders on antenatal mental outcomes - results from the Norwegian Mother, Father, and Child Cohort Study

Miliza Zugic¹, Nhung TH Trinh¹, Hedvig Nordeng^1,2, Angela Lupattelli¹

1) Department of Pharmacy, University of Oslo, Oslo, Norway

2) Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway

Introduction: The lack of evidence on the effectiveness of antidepressants in pregnant women with eating disorders (EDs) poses important challenges regarding clinical recommendations on pharmacological treatment.

Aims: To investigate the effectiveness of antidepressant treatment in pregnant women with EDs on symptom severity of depression and anxiety in early and late pregnancy. Additionally, to determine whether antidepressant treatment is associated with levels of joy and anger in late pregnancy.
Methods: We used data from the Norwegian Mother, Father and Child Cohort Study (MoBa), linked to the Medical Birth Registry of Norway (MBRN). Based on MoBa questionnaires Q1 (at week 17) and Q3 (week 30), we identified the presence of ED (AN- anorexia nervosa, BN- bulimia nervosa, BED- binge eating disorder and EDNOS-P- recurrent self-induced purging in the absence of binge eating) and exposure to antidepressants, from six months before through late pregnancy. Our outcomes were symptoms of depression and anxiety and levels of joy and anger, as measured via the Symptom Checklist scale in Q1 and Q3 and corresponding subscales from the Differential Emotions Scale in Q3, respectively. We estimated the association between antidepressant continuation in early or late pregnancy on maternal mental outcomes in the corresponding period. We adjusted for measured confounding via inverse probability of treatment weighting, and fit generalised linear models. Results are presented as outcome mean difference with 95% Confidence Intervals (CI). 
Results (To be updated!): We identified 6739 pregnancies with ED before and/or during early pregnancy: 0.7% AN (n=50), 11.3% BN (n=763), 86.5% BED (n=5830) and 1.4% EDNOS-P (n=96). Of these, 95.3% (n=6424) did not use antidepressants six months before or during pregnancy. The remaining 4.7% of the pregnancies were exposed to antidepressants in the six months pre-pregnancy, and either discontinued use before pregnancy (n=101) or during pregnancy (n=101) or continued (n=55) treatment throughout pregnancy. Women who continued antidepressants throughout pregnancy had lower depressive/anxiety symptoms in early but not late pregnancy than women who discontinued antidepressant treatment during pregnancy [β: -0.34, 95%CI (-0.60, -0.08)]. This association was only relevant in women with BED but not for BN. There was no association between continued use of antidepressants and maternal outcomes relative to discontinuation before pregnancy. Furthermore, the status of antidepressant treatment was not associated with levels of joy and anger in late pregnancy.


Conclusions: Continuation of antidepressants throughout pregnancy in women with ED is associated with lower symptoms of depression and anxiety in early pregnancy relative to discontinuation of treatment during pregnancy, albeit with a small effect size. This association is not evident in relation to depressive and anxiety symptoms in late pregnancy.