Staying on Antidepressants During Pregnancy Increases Risk of Obstetric Complications, Postpartum Psychiatric Disorders

Women with chronic depression who maintained their antidepressant therapy during and after pregnancy had more frequent obstetric complications and postpartum psychiatric disorders compared with women who permanently or temporarily discontinued their antidepressants, according to a study in the British Journal of Clinical Pharmacology. Women in this study stopped their antidepressant treatment during pregnancy and resumed afterwards also required a higher level of prescriptions for benzodiazepines and anxiolytics than what they needed before their pregnancy.

In the cohort study, the General Sample of Beneficiaries (EGB) database affiliated with the French Health Insurance System was used to identify women who gave birth between 2009 and 2014 and who were chronically treated with antidepressants within 6 months prior to giving birth (n=760). Reimbursement data for antidepressants were used to identify drug exposure prior to, during, and after birth. All women were followed until 6 months after childbirth. Outcomes included pregnancy and childbirth complications, psychiatric events or complications, and reimbursement for benzodiazepines and anxiolytics.

Approximately 55.8% of women permanently discontinued their antidepressants in their first trimester, whereas 20.4% of patients discontinued their antidepressant medications for ≥3 months and resumed after childbirth. Another 23.8% of women maintained their antidepressant use throughout their pregnancy and postpartum. At time of delivery, the maternal age was significantly higher among women who maintained their therapy vs those who stopped treatment during pregnancy (33.3±5.2 vs 31.8±5.5 years, respectively; P =.02).

Women who continued taking their antidepressant medications during and after pregnancy had more frequent obstetric complications, including fetal distress (odds ratio [OR], 1.77; 95% CI, 1.19–2.63) and higher risk for non-reassuring fetal heart rate (OR, 1.74; 95% CI, 1.11–2.73). Premature delivery was less frequent among those who stopped antidepressants vs those who either maintained (OR, 1.84; 95% CI, 0.99–3.41) or interrupted (OR, 1.93; 95% CI, 1.02–3.64) therapy. Women who maintained their antidepressants also had more frequent postpartum hemorrhage compared with women who interrupted (OR, 2.54; 95% CI, 1.31–4.91) and stopped (OR, 3.33; 95% CI, 1.28-8.66) treatment.

Additionally, women who maintained therapy during pregnancy had significantly more frequent psychiatric comorbidities during hospitalization or ALD for depression-anxiety compared with women who stopped (15.5% vs 2.4%, respectively; P <.001) and interrupted (15.5% vs 6.5%; P <.001) antidepressant use during pregnancy. Women who maintained antidepressant use during pregnancy also had a higher rate of postpartum psychiatric comorbidities during hospitalization or ALD for psychiatric disorders related to the puerperium (24.3%) compared with women who interrupted (10.3%) and ceased (5.0%) therapy (P <.001 for all). A multivariable analysis confirmed this finding (maintained/interrupted: OR, 3.23; 95% CI, 1.70–6.13 vs maintained/stopped: OR, 6.88; 95% CI, 3.87–12.2).

Over the 6-month follow-up period after delivery, a lower rate of prescriptions for benzodiazepine compared with before pregnancy was observed in the stopped group (8.5% vs 42%; P <.001) and in the maintained group (30.4% vs 46.6%; P <.001). Dispensed benzodiazepines decreased to 13.6% in the interrupted group but increased to a significantly higher level over the 6 months after childbirth than pre-pregnancy levels (54.2% vs 40.7%; P =.005).

A limitation of the study included the lack of information as to whether dispensed medications were actually taken.

The researchers concluded that the detection “of pregnancy in an antidepressant-treated woman requires re-evaluation of psychiatric treatment, not only assessing the events of the 6 months preceding the pregnancy, but more generally, her history of depression.”

Reference

Cabaillot A, Bourset A, Mulliez A, et al. Trajectories of antidepressant drugs during pregnancy: A cohort study from a community-based sample [published online August 4, 2020]. Br J Clin Pharmacol. doi: 10.1111/bcp.14449.