Selective serotonin reuptake inhibitorprescribing before, during and after pregnancy:a population-based study in six Europeanregions

RA Charlton, S Jordan, A Pierini, E Garne, AJ Neville, AV Hansen, R Gini, D Thayer, K Tingay, A Puccini, HJ Bos, AM Nybo Andersen, Marlene Sinclair, Helen Dolk, LTW de Jong-van den Berg

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Objective To explore the prescribing patterns of selectiveserotonin reuptake inhibitors (SSRIs) before, during and afterpregnancy in six European population-based databases.Design Descriptive drug utilisation study.Setting Six electronic healthcare databases in Denmark, theNetherlands, Italy (Emilia Romagna/Tuscany), Wales and the restof the UK.Population All women with a pregnancy ending in a live orstillbirth starting and ending between 2004 and 2010.Methods A common protocol was implemented across databasesto identify SSRI prescriptions issued (UK) or dispensed(non-UK) in the year before, during or in the year followingpregnancy.Main outcome measures The percentage of deliveries in whichthe woman received an SSRI prescription in the year before,during or in the year following pregnancy. We also comparedthe choice of SSRIs and changes in prescribing over the studyperiod.Results In total, 721 632 women and 862 943 deliveries wereidentified. In the year preceding pregnancy, the prevalence ofSSRI prescribing was highest in Wales [9.6%; 95% confidenceinterval (CI95), 9.4–9.8%] and lowest in Emilia Romagna (3.3%;CI95, 3.2–3.4%). During pregnancy, SSRI prescribing haddropped to between 1.2% (CI95, 1.1–1.3%) in Emilia Romagnaand 4.5% (CI95, 4.3–4.6%) in Wales. The higher UKpre-pregnancy prescribing rates resulted in higher first trimesterexposures. After pregnancy, SSRI prescribing increased mostrapidly in the UK. Paroxetine was more commonly prescribed inthe Netherlands and Italian regions than in Denmark and theUK.Conclusions The higher SSRI prescribing rates in the UK,compared with other European regions, raise questions aboutdifferences in the prevalence and severity of depression and itsmanagement in pregnancy across Europe.Keywords Drug utilisation, electronic health records, pregnancy,serotonin uptake inhibitors.
LanguageEnglish
Pages1010-1020
JournalBJOG an International Journal of Obstetrics and Gynaecology
Volumeearly
Early online date28 Oct 2014
DOIs
Publication statusE-pub ahead of print - 28 Oct 2014

Fingerprint

Serotonin
Pregnancy
Wales
Population
Drug Utilization
Denmark
Prescriptions
Databases
Paroxetine
Electronic Health Records
Serotonin Uptake Inhibitors
Pregnancy Rate
Netherlands
Italy
Outcome Assessment (Health Care)
Delivery of Health Care

Keywords

  • Drug utilisation
  • electronic health records
  • pregnancy
  • serotonin uptake inhibitors.

Cite this

Charlton, RA ; Jordan, S ; Pierini, A ; Garne, E ; Neville, AJ ; Hansen, AV ; Gini, R ; Thayer, D ; Tingay, K ; Puccini, A ; Bos, HJ ; Nybo Andersen, AM ; Sinclair, Marlene ; Dolk, Helen ; de Jong-van den Berg, LTW. / Selective serotonin reuptake inhibitorprescribing before, during and after pregnancy:a population-based study in six Europeanregions. In: BJOG an International Journal of Obstetrics and Gynaecology. 2014 ; Vol. early. pp. 1010-1020.
@article{fae80c36a1444c32899f4057b58d5de8,
title = "Selective serotonin reuptake inhibitorprescribing before, during and after pregnancy:a population-based study in six Europeanregions",
abstract = "Objective To explore the prescribing patterns of selectiveserotonin reuptake inhibitors (SSRIs) before, during and afterpregnancy in six European population-based databases.Design Descriptive drug utilisation study.Setting Six electronic healthcare databases in Denmark, theNetherlands, Italy (Emilia Romagna/Tuscany), Wales and the restof the UK.Population All women with a pregnancy ending in a live orstillbirth starting and ending between 2004 and 2010.Methods A common protocol was implemented across databasesto identify SSRI prescriptions issued (UK) or dispensed(non-UK) in the year before, during or in the year followingpregnancy.Main outcome measures The percentage of deliveries in whichthe woman received an SSRI prescription in the year before,during or in the year following pregnancy. We also comparedthe choice of SSRIs and changes in prescribing over the studyperiod.Results In total, 721 632 women and 862 943 deliveries wereidentified. In the year preceding pregnancy, the prevalence ofSSRI prescribing was highest in Wales [9.6{\%}; 95{\%} confidenceinterval (CI95), 9.4–9.8{\%}] and lowest in Emilia Romagna (3.3{\%};CI95, 3.2–3.4{\%}). During pregnancy, SSRI prescribing haddropped to between 1.2{\%} (CI95, 1.1–1.3{\%}) in Emilia Romagnaand 4.5{\%} (CI95, 4.3–4.6{\%}) in Wales. The higher UKpre-pregnancy prescribing rates resulted in higher first trimesterexposures. After pregnancy, SSRI prescribing increased mostrapidly in the UK. Paroxetine was more commonly prescribed inthe Netherlands and Italian regions than in Denmark and theUK.Conclusions The higher SSRI prescribing rates in the UK,compared with other European regions, raise questions aboutdifferences in the prevalence and severity of depression and itsmanagement in pregnancy across Europe.Keywords Drug utilisation, electronic health records, pregnancy,serotonin uptake inhibitors.",
keywords = "Drug utilisation, electronic health records, pregnancy, serotonin uptake inhibitors.",
author = "RA Charlton and S Jordan and A Pierini and E Garne and AJ Neville and AV Hansen and R Gini and D Thayer and K Tingay and A Puccini and HJ Bos and {Nybo Andersen}, AM and Marlene Sinclair and Helen Dolk and {de Jong-van den Berg}, LTW",
note = "Reference text: References 1 King M, Nazareth I, Levy G, Walker C, Morris R, Weich S, et al. Prevalence of common mental disorders in general practice attendees across Europe. Br J Psychiatry 2008;192:362–7. 2 Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 2005;106:1071–83. 3 Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 2004;103:698–709. 4 Gruppo di lavoro OsMed. L’uso dei farmaci in Italia. Rapporto nazionale anno 2007 [OsMedWorking Team. The Drug Utilisation in Italy. National Reports 2007]. Rome: Il Pensiero Scientifico Editore; 2008 [www.agenziafarmaco.gov.it/sites/default/files/rapporto_osmed_ 2007_0.pdf]. Accessed 23 July 2014. 5 Reefhuis J, Rasmussen SA, Friedman JM. Selective serotoninreuptake inhibitors and persistent pulmonary hypertension of the newborn. N Engl J Med 2006;354:2188–90. 6 Cooper WO, Willy ME, Pont SJ, Ray WA. Increasing use of antidepressants in pregnancy. Am J Obstet Gynecol 2007;196: 544.e541–5. 7 Alwan S, Reefhuis J, Rasmussen SA, Friedman JM, National Birth Defects Prevention Service. Patterns of antidepressant medication use among pregnant women in a United States population. J Clin Pharmacol 2011;51:264–70. 8 Bakker MK, K€olling P, Van Den Berg PB, De Walle HEK, De Jong van den Berg LTW. Increase in use of selective serotonin reuptake inhibitors in pregnancy during the last decade, a population-based cohort study from the Netherlands. J Clin Pharmacol 2008;65: 600–6. ª 2014 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of 9 Royal College of Obstetricians and Gynaecologists. 9 Colvin L, Slack-Smith L, Stanley FJ, Bower C. Dispensing patterns and pregnancy outcomes for women dispensed selective serotonin reuptake inhibitors in pregnancy. Birth Defects Res A Clin Mol Teratol 2011;91:142–52. 10 Lattimore KA, Donn SM, Kaciroti N, Kemper AR, Neal CR, Vazquez DM. Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and effects on the fetus and newborn: a meta-analysis. J Perinatol 2005;25:595–604. 11 Nikfar S, Rahimi R, Hendoiee N, Abdollahi M. Increasing the risk of spontaneous abortion and major malformations in newborns following use of serotonin reuptake inhibitors during pregnancy: a systematic review and updated meta-analysis. Daru 2012;20:75. 12 Bakker MK, Kerstjens-Frederikse WS, Buys CH, de Walle HE, de Jong-van den Berg LT. First-trimester use of paroxetine and congenital heart defects: a population-based case–control study. Birth Defects Res A Clin Mol Teratol 2010;88:94–100. 13 Chambers CD, Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Jones KL, et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med 2006;354:579–87. 14 Kieler H, Artama M, Engeland A, Ericsson €O, Furu K, Gissler M, et al. Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: population based cohort study from the five Nordic countries. BMJ 2012;344:d8012. 15 Gentile S. The safety of newer antidepressants in pregnancy and breastfeeding. Drug Saf 2005;28:137–52. 16 Toh S, Mitchell AA, Louik C, Werler MM, Chambers CD, Hernandez-Diaz S. Selective serotonin reuptake inhibitor use and risk of gestational hypertension. Am J Psychiatry 2009;166: 320–8. 17 Cohen L, Altshuler L, Harlow B, Nonacs R, Newport D, Viguera A, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. J Am Med Assoc 2006;295:499–507. 18 Singh S, Sedgh G, Hussain R. Unintended pregnancy: worldwide levels, trends, and outcomes. Stud Fam Plann 2010;41:241–50. 19 EUROmediCAT. Safety of Medication Use in Pregnancy. 2011 [http://euromedicat.eu/]. Accessed 31 July 2014. 20 Dolk H. EUROCAT: 25 years of European surveillance of congenital anomalies. Arch Dis Child Fetal Neonatal Ed 2005;90:F355–8. 21 Coloma PM, Trifiro G, Schuemie MJ, Gini R, Herings R, Hippisley-Cox J, et al. Electronic healthcare databases for active drug safety surveillance: is there enough leverage? Pharmacoepidemiol Drug Saf 2012;21:611–21. 22 Gagne JJ, Maio V, Berghella V, Louis DZ, Gonnella JS. Prescription drug use during pregnancy: a population-based study in Regione Emilia-Romagna, Italy. Eur J Clin Pharmacol 2008;64:1125–32. 23 Ford D, Jones K, Verplancke J-P, Lyons R, John G, Brown G, et al. The SAIL Databank: building a national architecture for e-health research and evaluation. BMC Health Serv Res 2009;9:157. 24 Lyons R, Jones K, John G, Brooks C, Verplancke J-P, Ford D, et al. The SAIL databank: linking multiple health and social care datasets. BMC Med Inform Decis Mak 2009;9:3. 25 Wood L, Martinez C. The General Practice Research Database: role in pharmacovigilance. Drug Saf 2004;27:871–81. 26 Thygesen LC, Daasnes C, Thaulow I, Br{\o}nnum-Hansen H. Introduction to Danish (nationwide) registers on health and social issues: structure, access, legislation, and archiving. Scand J Public Health 2011;39(7 Suppl):12–16. 27 Lynge E, Sandegaard JL, Rebolj M. The Danish National Patient Register. Scand J Public Health 2011;39(7 Suppl):30–3. 28 Wallach Kildemoes H, Toft S{\o}rensen H, Hallas J. The Danish National Prescription Registry. Scand J Public Health 2011;39(7 Suppl):38–41. 29 Visser ST, Schuiling-Veninga CCM, Bos JHJ, de Jong-van den Berg LTW, Postma MJ. The population-based prescription database IADB. nl: its development, usefulness in outcomes research and challenges. Expert Rev Pharmacoecon Outcomes Res 2013;13:285–92. 30 Charlton RA, Neville AJ, Jordan S, Pierini A, Damase-Michel C, Klungs{\o}yr K, et al. Healthcare databases in Europe for studying medicine use and safety during pregnancy. Pharmacoepidemiol Drug Saf 2014;23:586–94. 31 van Gelder MHJ, Rooij ILM, Walle HK, Roeleveld N, Bakker M. Maternal recall of prescription medication use during pregnancy using a paper-based questionnaire. Drug Saf 2013;36:43–54. 32 Jordan S, Watkins A, Storey M, Allen SJ, Brooks CJ, Garaiova I, et al. Volunteer bias in recruitment, retention, and blood sample donation in a randomised controlled trial involving mothers and their children at six months and two years: a longitudinal analysis. PLoS One 2013;8:e67912. 33 van Geffen ECG, Gardarsdottir H, van Hulten R, van Dijk L, Egberts ACG, Heerdink ER. Initiation of antidepressant therapy: do patients follow the GP’s prescription? Br J Gen Pract 2009;59:81–7. 34 Beardon PH, McGilchrist MM, McKendrick AD, McDevitt DG, MacDonald TM. Primary non-compliance with prescribed medication in primary care. BMJ 1993;307:846–8. 35 Fischer MA, Stedman MR, Lii J, Vogeli C, Shrank WH, Brookhart A, et al. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med 2010;25:284–90. 36 National Institute for Health and Clinical Excellence. Antenatal and postnatal mental health. Clinical management and service guidance. 2007 [www.nice.org.uk/guidance/cg45/resources/guidanceantenatal- and-postnatal-mental-health-pdf]. Accessed 18 August 2014. 37 Petersen I, Gilbert RE, Evans SJ, Man SL, Nazareth I. Pregnancy as a major determinant for discontinuation of antidepressants: an analysis of data from The Health Improvement Network. J Clin Psychiatry 2011;72:979–85. 38 Ververs T, Kaasenbrood H, Visser G, Schobben F, Jong-van den Berg L, Egberts T. Prevalence and patterns of antidepressant drug use during pregnancy. Eur J Clin Pharmacol 2006;62:863–70. 39 Engelbrecht AST. Forbruget af Antidepressiva 2001–2011. Dataleverancer og L{\ae}gemiddelstatistik Sektor for National Sundhedsdokumentation og Forskning. Copenhagen: Statens Serum Institute, 2012. 21 May 2013. 40 Andrade SE, Raebel MA, Brown J, Lane K, Livingston J, Boudreau D, et al. Use of antidepressant medications during pregnancy: a multisite study. Am J Obstet Gynecol 2008;198:194.e191–5. 41 Huybrechts KF, Palmsten K, Mogun H, Kowal M, Avorn J, Setoguchi-Iwata S, et al. National trends in antidepressant medication treatment among publicly insured pregnant women. Gen Hosp Psychiatry 2013;35:265–71. 42 Ramos E, Oraichi D, Rey E, Blais L, Berard A. Prevalence and predictors of antidepressant use in a cohort of pregnant women. BJOG 2007;114:1055–64. 43 Heaney P. Antidepressant prescriptions up amid therapy delays. 2012 [www.bbc.co.uk/news/uk-wales-19289669]. Accessed 12 November 2013. 44 Office for National Statistics. Regional Gross Disposable Household Income (GDHI) 2011. 2013 [www.ons.gov.uk/ons/dcp1717 78_307651.pdf]. Accessed 1 October 2013. 45 Damiani G, Federico B, Silvestrini G, Bianchi C, Anselmi A, Iodice L, et al. Impact of regional copayment policy on selective serotonin reuptake inhibitor (SSRI) consumption and expenditure in Italy. Eur J Clin Pharmacol 2013;69:957–63. 10 ª 2014 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of46 Wurst KE, Poole C, Ephross SA, Olshan AF. First trimester paroxetine use and the prevalence of congenital, specifically cardiac, defects: a meta-analysis of epidemiological studies. Birth Defects Res A Clin Mol Teratol 2010;88:159–70. 47 Nederlandse Vereniging voor obstetrie en gynaecologie (NVOG). Richtlijn. SSRI-gebruik in de zwangerschap en tijdens lactatie. 2012 [www.nvog-documenten.nl]. Accessed 5 May 2013. 48 Agenzia Italiana del Farmaco AIFA. Nota informativa importante concordata con le autorita regolatorie Europee e l’Agenzia Italiana del Farmaco (AIFA). 2006 [www.agenziafarmaco.gov.it/sites/default/ files/111.86876.11401890146983587.pdf]. Accessed 30 September 2013. 49 Agenzia Italiana del Farmaco AIFA. Raccomandazioni del Working Group Pediatrico dell’AIFA in relazione all’eposizione in utero di antidepressivi. 2010 [www.agenziafarmaco.gov.it/sites/default/files/ paroxetina_raccomandazione_wgp_23112010.pdf]. Accessed 30 September 2013. 50 Videbech P, Christensen KS, Hansen PEB. Antidepressiv behandling af gravide 2013. [http://pro.medicin.dk/Sygdomme/Sygdom/318339]. Accessed 25 August 2014. 51 Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. J Am Med Assoc 2010;303:47–53. 52 McAndrew F, Thompson J, Fellows L, Large A, Speed M, Renfrew M. The Infant Feeding Survey 2010. NHS Information Centre for Health and Social Care, Office of National Statistics. 2012 [http://data.gov.uk/ dataset/infant-feeding-survey-2010]. Accessed 22 June 2013. 53 Lauria L, Spinelli A, Lamberti A, Buoncritiano M, Bucciarelli M, Andreozzi S, et al. Breastfeeding: prevalences, duration and associated factors from two Italian surveys – 2008 and 2011. Not Ist Super Sanita 2012;25:i–iii. [www.epicentro.iss.it/ben/2012/ november/2011.asp]. Accessed 30 January 2014. 54 Busck-Rasmussen M, Fredsted Villadsen S, Nyboe Norsker F, Mortensen L, Nybo Andersen A. Breastfeeding practices in relation to country of origin among women living in Denmark: a population- based study. Matern Child Health J 2014; DOI: 10.1007/s10995- 014-1486-z [Epub ahead of print]. 55 UK National Screening Committee. Postnatal depression screening policy position statement. 2011 [www.screening.nhs.uk/ policydb_download.php?doc=189]. Accessed 1 October 2013.",
year = "2014",
month = "10",
day = "28",
doi = "10.1111/1471-0528.13143",
language = "English",
volume = "early",
pages = "1010--1020",
journal = "BJOG: An International Journal of Obstetrics and Gynaecology",
issn = "1470-0328",

}

Charlton, RA, Jordan, S, Pierini, A, Garne, E, Neville, AJ, Hansen, AV, Gini, R, Thayer, D, Tingay, K, Puccini, A, Bos, HJ, Nybo Andersen, AM, Sinclair, M, Dolk, H & de Jong-van den Berg, LTW 2014, 'Selective serotonin reuptake inhibitorprescribing before, during and after pregnancy:a population-based study in six Europeanregions', BJOG an International Journal of Obstetrics and Gynaecology, vol. early, pp. 1010-1020. https://doi.org/10.1111/1471-0528.13143

Selective serotonin reuptake inhibitorprescribing before, during and after pregnancy:a population-based study in six Europeanregions. / Charlton, RA; Jordan, S; Pierini, A; Garne, E; Neville, AJ; Hansen, AV; Gini, R; Thayer, D; Tingay, K; Puccini, A; Bos, HJ; Nybo Andersen, AM; Sinclair, Marlene; Dolk, Helen; de Jong-van den Berg, LTW.

In: BJOG an International Journal of Obstetrics and Gynaecology, Vol. early, 28.10.2014, p. 1010-1020.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Selective serotonin reuptake inhibitorprescribing before, during and after pregnancy:a population-based study in six Europeanregions

AU - Charlton, RA

AU - Jordan, S

AU - Pierini, A

AU - Garne, E

AU - Neville, AJ

AU - Hansen, AV

AU - Gini, R

AU - Thayer, D

AU - Tingay, K

AU - Puccini, A

AU - Bos, HJ

AU - Nybo Andersen, AM

AU - Sinclair, Marlene

AU - Dolk, Helen

AU - de Jong-van den Berg, LTW

N1 - Reference text: References 1 King M, Nazareth I, Levy G, Walker C, Morris R, Weich S, et al. Prevalence of common mental disorders in general practice attendees across Europe. Br J Psychiatry 2008;192:362–7. 2 Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 2005;106:1071–83. 3 Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 2004;103:698–709. 4 Gruppo di lavoro OsMed. L’uso dei farmaci in Italia. Rapporto nazionale anno 2007 [OsMedWorking Team. The Drug Utilisation in Italy. National Reports 2007]. Rome: Il Pensiero Scientifico Editore; 2008 [www.agenziafarmaco.gov.it/sites/default/files/rapporto_osmed_ 2007_0.pdf]. Accessed 23 July 2014. 5 Reefhuis J, Rasmussen SA, Friedman JM. Selective serotoninreuptake inhibitors and persistent pulmonary hypertension of the newborn. N Engl J Med 2006;354:2188–90. 6 Cooper WO, Willy ME, Pont SJ, Ray WA. Increasing use of antidepressants in pregnancy. Am J Obstet Gynecol 2007;196: 544.e541–5. 7 Alwan S, Reefhuis J, Rasmussen SA, Friedman JM, National Birth Defects Prevention Service. Patterns of antidepressant medication use among pregnant women in a United States population. J Clin Pharmacol 2011;51:264–70. 8 Bakker MK, K€olling P, Van Den Berg PB, De Walle HEK, De Jong van den Berg LTW. Increase in use of selective serotonin reuptake inhibitors in pregnancy during the last decade, a population-based cohort study from the Netherlands. J Clin Pharmacol 2008;65: 600–6. ª 2014 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of 9 Royal College of Obstetricians and Gynaecologists. 9 Colvin L, Slack-Smith L, Stanley FJ, Bower C. Dispensing patterns and pregnancy outcomes for women dispensed selective serotonin reuptake inhibitors in pregnancy. Birth Defects Res A Clin Mol Teratol 2011;91:142–52. 10 Lattimore KA, Donn SM, Kaciroti N, Kemper AR, Neal CR, Vazquez DM. Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and effects on the fetus and newborn: a meta-analysis. J Perinatol 2005;25:595–604. 11 Nikfar S, Rahimi R, Hendoiee N, Abdollahi M. Increasing the risk of spontaneous abortion and major malformations in newborns following use of serotonin reuptake inhibitors during pregnancy: a systematic review and updated meta-analysis. Daru 2012;20:75. 12 Bakker MK, Kerstjens-Frederikse WS, Buys CH, de Walle HE, de Jong-van den Berg LT. First-trimester use of paroxetine and congenital heart defects: a population-based case–control study. Birth Defects Res A Clin Mol Teratol 2010;88:94–100. 13 Chambers CD, Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Jones KL, et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med 2006;354:579–87. 14 Kieler H, Artama M, Engeland A, Ericsson €O, Furu K, Gissler M, et al. Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: population based cohort study from the five Nordic countries. BMJ 2012;344:d8012. 15 Gentile S. The safety of newer antidepressants in pregnancy and breastfeeding. Drug Saf 2005;28:137–52. 16 Toh S, Mitchell AA, Louik C, Werler MM, Chambers CD, Hernandez-Diaz S. Selective serotonin reuptake inhibitor use and risk of gestational hypertension. Am J Psychiatry 2009;166: 320–8. 17 Cohen L, Altshuler L, Harlow B, Nonacs R, Newport D, Viguera A, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. J Am Med Assoc 2006;295:499–507. 18 Singh S, Sedgh G, Hussain R. Unintended pregnancy: worldwide levels, trends, and outcomes. Stud Fam Plann 2010;41:241–50. 19 EUROmediCAT. Safety of Medication Use in Pregnancy. 2011 [http://euromedicat.eu/]. Accessed 31 July 2014. 20 Dolk H. EUROCAT: 25 years of European surveillance of congenital anomalies. Arch Dis Child Fetal Neonatal Ed 2005;90:F355–8. 21 Coloma PM, Trifiro G, Schuemie MJ, Gini R, Herings R, Hippisley-Cox J, et al. Electronic healthcare databases for active drug safety surveillance: is there enough leverage? Pharmacoepidemiol Drug Saf 2012;21:611–21. 22 Gagne JJ, Maio V, Berghella V, Louis DZ, Gonnella JS. Prescription drug use during pregnancy: a population-based study in Regione Emilia-Romagna, Italy. Eur J Clin Pharmacol 2008;64:1125–32. 23 Ford D, Jones K, Verplancke J-P, Lyons R, John G, Brown G, et al. The SAIL Databank: building a national architecture for e-health research and evaluation. BMC Health Serv Res 2009;9:157. 24 Lyons R, Jones K, John G, Brooks C, Verplancke J-P, Ford D, et al. The SAIL databank: linking multiple health and social care datasets. BMC Med Inform Decis Mak 2009;9:3. 25 Wood L, Martinez C. The General Practice Research Database: role in pharmacovigilance. Drug Saf 2004;27:871–81. 26 Thygesen LC, Daasnes C, Thaulow I, Brønnum-Hansen H. Introduction to Danish (nationwide) registers on health and social issues: structure, access, legislation, and archiving. Scand J Public Health 2011;39(7 Suppl):12–16. 27 Lynge E, Sandegaard JL, Rebolj M. The Danish National Patient Register. Scand J Public Health 2011;39(7 Suppl):30–3. 28 Wallach Kildemoes H, Toft Sørensen H, Hallas J. The Danish National Prescription Registry. Scand J Public Health 2011;39(7 Suppl):38–41. 29 Visser ST, Schuiling-Veninga CCM, Bos JHJ, de Jong-van den Berg LTW, Postma MJ. The population-based prescription database IADB. nl: its development, usefulness in outcomes research and challenges. Expert Rev Pharmacoecon Outcomes Res 2013;13:285–92. 30 Charlton RA, Neville AJ, Jordan S, Pierini A, Damase-Michel C, Klungsøyr K, et al. Healthcare databases in Europe for studying medicine use and safety during pregnancy. Pharmacoepidemiol Drug Saf 2014;23:586–94. 31 van Gelder MHJ, Rooij ILM, Walle HK, Roeleveld N, Bakker M. Maternal recall of prescription medication use during pregnancy using a paper-based questionnaire. Drug Saf 2013;36:43–54. 32 Jordan S, Watkins A, Storey M, Allen SJ, Brooks CJ, Garaiova I, et al. Volunteer bias in recruitment, retention, and blood sample donation in a randomised controlled trial involving mothers and their children at six months and two years: a longitudinal analysis. PLoS One 2013;8:e67912. 33 van Geffen ECG, Gardarsdottir H, van Hulten R, van Dijk L, Egberts ACG, Heerdink ER. Initiation of antidepressant therapy: do patients follow the GP’s prescription? Br J Gen Pract 2009;59:81–7. 34 Beardon PH, McGilchrist MM, McKendrick AD, McDevitt DG, MacDonald TM. Primary non-compliance with prescribed medication in primary care. BMJ 1993;307:846–8. 35 Fischer MA, Stedman MR, Lii J, Vogeli C, Shrank WH, Brookhart A, et al. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med 2010;25:284–90. 36 National Institute for Health and Clinical Excellence. Antenatal and postnatal mental health. Clinical management and service guidance. 2007 [www.nice.org.uk/guidance/cg45/resources/guidanceantenatal- and-postnatal-mental-health-pdf]. Accessed 18 August 2014. 37 Petersen I, Gilbert RE, Evans SJ, Man SL, Nazareth I. Pregnancy as a major determinant for discontinuation of antidepressants: an analysis of data from The Health Improvement Network. J Clin Psychiatry 2011;72:979–85. 38 Ververs T, Kaasenbrood H, Visser G, Schobben F, Jong-van den Berg L, Egberts T. Prevalence and patterns of antidepressant drug use during pregnancy. Eur J Clin Pharmacol 2006;62:863–70. 39 Engelbrecht AST. Forbruget af Antidepressiva 2001–2011. Dataleverancer og Lægemiddelstatistik Sektor for National Sundhedsdokumentation og Forskning. Copenhagen: Statens Serum Institute, 2012. 21 May 2013. 40 Andrade SE, Raebel MA, Brown J, Lane K, Livingston J, Boudreau D, et al. Use of antidepressant medications during pregnancy: a multisite study. Am J Obstet Gynecol 2008;198:194.e191–5. 41 Huybrechts KF, Palmsten K, Mogun H, Kowal M, Avorn J, Setoguchi-Iwata S, et al. National trends in antidepressant medication treatment among publicly insured pregnant women. Gen Hosp Psychiatry 2013;35:265–71. 42 Ramos E, Oraichi D, Rey E, Blais L, Berard A. Prevalence and predictors of antidepressant use in a cohort of pregnant women. BJOG 2007;114:1055–64. 43 Heaney P. Antidepressant prescriptions up amid therapy delays. 2012 [www.bbc.co.uk/news/uk-wales-19289669]. Accessed 12 November 2013. 44 Office for National Statistics. Regional Gross Disposable Household Income (GDHI) 2011. 2013 [www.ons.gov.uk/ons/dcp1717 78_307651.pdf]. Accessed 1 October 2013. 45 Damiani G, Federico B, Silvestrini G, Bianchi C, Anselmi A, Iodice L, et al. Impact of regional copayment policy on selective serotonin reuptake inhibitor (SSRI) consumption and expenditure in Italy. Eur J Clin Pharmacol 2013;69:957–63. 10 ª 2014 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of46 Wurst KE, Poole C, Ephross SA, Olshan AF. First trimester paroxetine use and the prevalence of congenital, specifically cardiac, defects: a meta-analysis of epidemiological studies. Birth Defects Res A Clin Mol Teratol 2010;88:159–70. 47 Nederlandse Vereniging voor obstetrie en gynaecologie (NVOG). Richtlijn. SSRI-gebruik in de zwangerschap en tijdens lactatie. 2012 [www.nvog-documenten.nl]. Accessed 5 May 2013. 48 Agenzia Italiana del Farmaco AIFA. Nota informativa importante concordata con le autorita regolatorie Europee e l’Agenzia Italiana del Farmaco (AIFA). 2006 [www.agenziafarmaco.gov.it/sites/default/ files/111.86876.11401890146983587.pdf]. Accessed 30 September 2013. 49 Agenzia Italiana del Farmaco AIFA. Raccomandazioni del Working Group Pediatrico dell’AIFA in relazione all’eposizione in utero di antidepressivi. 2010 [www.agenziafarmaco.gov.it/sites/default/files/ paroxetina_raccomandazione_wgp_23112010.pdf]. Accessed 30 September 2013. 50 Videbech P, Christensen KS, Hansen PEB. Antidepressiv behandling af gravide 2013. [http://pro.medicin.dk/Sygdomme/Sygdom/318339]. Accessed 25 August 2014. 51 Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. J Am Med Assoc 2010;303:47–53. 52 McAndrew F, Thompson J, Fellows L, Large A, Speed M, Renfrew M. The Infant Feeding Survey 2010. NHS Information Centre for Health and Social Care, Office of National Statistics. 2012 [http://data.gov.uk/ dataset/infant-feeding-survey-2010]. Accessed 22 June 2013. 53 Lauria L, Spinelli A, Lamberti A, Buoncritiano M, Bucciarelli M, Andreozzi S, et al. Breastfeeding: prevalences, duration and associated factors from two Italian surveys – 2008 and 2011. Not Ist Super Sanita 2012;25:i–iii. [www.epicentro.iss.it/ben/2012/ november/2011.asp]. Accessed 30 January 2014. 54 Busck-Rasmussen M, Fredsted Villadsen S, Nyboe Norsker F, Mortensen L, Nybo Andersen A. Breastfeeding practices in relation to country of origin among women living in Denmark: a population- based study. Matern Child Health J 2014; DOI: 10.1007/s10995- 014-1486-z [Epub ahead of print]. 55 UK National Screening Committee. Postnatal depression screening policy position statement. 2011 [www.screening.nhs.uk/ policydb_download.php?doc=189]. Accessed 1 October 2013.

PY - 2014/10/28

Y1 - 2014/10/28

N2 - Objective To explore the prescribing patterns of selectiveserotonin reuptake inhibitors (SSRIs) before, during and afterpregnancy in six European population-based databases.Design Descriptive drug utilisation study.Setting Six electronic healthcare databases in Denmark, theNetherlands, Italy (Emilia Romagna/Tuscany), Wales and the restof the UK.Population All women with a pregnancy ending in a live orstillbirth starting and ending between 2004 and 2010.Methods A common protocol was implemented across databasesto identify SSRI prescriptions issued (UK) or dispensed(non-UK) in the year before, during or in the year followingpregnancy.Main outcome measures The percentage of deliveries in whichthe woman received an SSRI prescription in the year before,during or in the year following pregnancy. We also comparedthe choice of SSRIs and changes in prescribing over the studyperiod.Results In total, 721 632 women and 862 943 deliveries wereidentified. In the year preceding pregnancy, the prevalence ofSSRI prescribing was highest in Wales [9.6%; 95% confidenceinterval (CI95), 9.4–9.8%] and lowest in Emilia Romagna (3.3%;CI95, 3.2–3.4%). During pregnancy, SSRI prescribing haddropped to between 1.2% (CI95, 1.1–1.3%) in Emilia Romagnaand 4.5% (CI95, 4.3–4.6%) in Wales. The higher UKpre-pregnancy prescribing rates resulted in higher first trimesterexposures. After pregnancy, SSRI prescribing increased mostrapidly in the UK. Paroxetine was more commonly prescribed inthe Netherlands and Italian regions than in Denmark and theUK.Conclusions The higher SSRI prescribing rates in the UK,compared with other European regions, raise questions aboutdifferences in the prevalence and severity of depression and itsmanagement in pregnancy across Europe.Keywords Drug utilisation, electronic health records, pregnancy,serotonin uptake inhibitors.

AB - Objective To explore the prescribing patterns of selectiveserotonin reuptake inhibitors (SSRIs) before, during and afterpregnancy in six European population-based databases.Design Descriptive drug utilisation study.Setting Six electronic healthcare databases in Denmark, theNetherlands, Italy (Emilia Romagna/Tuscany), Wales and the restof the UK.Population All women with a pregnancy ending in a live orstillbirth starting and ending between 2004 and 2010.Methods A common protocol was implemented across databasesto identify SSRI prescriptions issued (UK) or dispensed(non-UK) in the year before, during or in the year followingpregnancy.Main outcome measures The percentage of deliveries in whichthe woman received an SSRI prescription in the year before,during or in the year following pregnancy. We also comparedthe choice of SSRIs and changes in prescribing over the studyperiod.Results In total, 721 632 women and 862 943 deliveries wereidentified. In the year preceding pregnancy, the prevalence ofSSRI prescribing was highest in Wales [9.6%; 95% confidenceinterval (CI95), 9.4–9.8%] and lowest in Emilia Romagna (3.3%;CI95, 3.2–3.4%). During pregnancy, SSRI prescribing haddropped to between 1.2% (CI95, 1.1–1.3%) in Emilia Romagnaand 4.5% (CI95, 4.3–4.6%) in Wales. The higher UKpre-pregnancy prescribing rates resulted in higher first trimesterexposures. After pregnancy, SSRI prescribing increased mostrapidly in the UK. Paroxetine was more commonly prescribed inthe Netherlands and Italian regions than in Denmark and theUK.Conclusions The higher SSRI prescribing rates in the UK,compared with other European regions, raise questions aboutdifferences in the prevalence and severity of depression and itsmanagement in pregnancy across Europe.Keywords Drug utilisation, electronic health records, pregnancy,serotonin uptake inhibitors.

KW - Drug utilisation

KW - electronic health records

KW - pregnancy

KW - serotonin uptake inhibitors.

UR - http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.13143/abstract

UR - https://pure.ulster.ac.uk/en/searchAll/index/?search=11478807&pageSize=25&showAdvanced=false&allConcepts=true&inferConcepts=true&searchBy=PartOfNameOrTitle

U2 - 10.1111/1471-0528.13143

DO - 10.1111/1471-0528.13143

M3 - Article

VL - early

SP - 1010

EP - 1020

JO - BJOG: An International Journal of Obstetrics and Gynaecology

T2 - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

SN - 1470-0328

ER -