Nina M Molenaar1, Babette Bais2, Mijke P Lambregtse-van den Berg3, Cornelis L Mulder4, Elizabeth A Howell5, Nathan S Fox6, Anna-Sophie Rommel7, Veerle Bergink8, Astrid M Kamperman4. 1. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States; Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: nina.molenaar@mssm.edu. 2. Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands. 3. Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Sophia's Children Hospital, Rotterdam, the Netherlands. 4. Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands; Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, Rotterdam, the Netherlands. 5. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States; Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, United States; Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, United States. 6. Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, United States. 7. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States. 8. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States; Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, United States; Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, United States.
Abstract
BACKGROUND: Antidepressant use during pregnancy has increased over the last decades, while safety has been under debate. Our aim was to measure the international prevalence of antidepressant use before, during, and after pregnancy and examine timing, type of prescriptions and geographic variability. METHODS: We searched Embase, Medline Ovid, Web of Science, Cochrane Central and Google Scholar from their inception until February 19, 2019. We determined pooled prevalence estimates of antidepressants before, during, and after pregnancy, as well as stratified according to substantive variables. RESULTS: We identified 40 cohorts from 15 countries, together reporting on 14,072,251 pregnancies. Included studies had a low risk of bias, often reporting on large representative cohorts. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly used antidepressants during pregnancy, with an international prevalence estimate of 3.0% (95%CI 2.3;3.7). While Europe and Australasia had pooled prevalence estimates of 1.6% and 1.3% respectively, Northern America had a prevalence estimate of 5.5% (Q-value = 126.19; df = 2; p-value<0.01). Highest SSRI prevalence rates were found for sertraline (1.10%), followed by citalopram and fluoxetine (0.77% and 0.76% respectively) (Q-value = 121.25; df = 5; p-value<0.01). Qualitative analysis indicated an increase in antidepressant use over subsequent calendar years. LIMITATIONS: Substantial heterogeneity remained unaccounted for throughout the analyses, even after accounting for hypothetical contributors. CONCLUSIONS: This meta-analysis revealed substantial regional differences in antidepressant use around pregnancy, which could be due to variability in prescription behavior, healthcare seeking behavior and organization of healthcare. There is an urgent need for evidence on effectiveness, benefit, and harm of antidepressants during pregnancy to guide clinical practice.
BACKGROUND: Antidepressant use during pregnancy has increased over the last decades, while safety has been under debate. Our aim was to measure the international prevalence of antidepressant use before, during, and after pregnancy and examine timing, type of prescriptions and geographic variability. METHODS: We searched Embase, Medline Ovid, Web of Science, Cochrane Central and Google Scholar from their inception until February 19, 2019. We determined pooled prevalence estimates of antidepressants before, during, and after pregnancy, as well as stratified according to substantive variables. RESULTS: We identified 40 cohorts from 15 countries, together reporting on 14,072,251 pregnancies. Included studies had a low risk of bias, often reporting on large representative cohorts. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly used antidepressants during pregnancy, with an international prevalence estimate of 3.0% (95%CI 2.3;3.7). While Europe and Australasia had pooled prevalence estimates of 1.6% and 1.3% respectively, Northern America had a prevalence estimate of 5.5% (Q-value = 126.19; df = 2; p-value<0.01). Highest SSRI prevalence rates were found for sertraline (1.10%), followed by citalopram and fluoxetine (0.77% and 0.76% respectively) (Q-value = 121.25; df = 5; p-value<0.01). Qualitative analysis indicated an increase in antidepressant use over subsequent calendar years. LIMITATIONS: Substantial heterogeneity remained unaccounted for throughout the analyses, even after accounting for hypothetical contributors. CONCLUSIONS: This meta-analysis revealed substantial regional differences in antidepressant use around pregnancy, which could be due to variability in prescription behavior, healthcare seeking behavior and organization of healthcare. There is an urgent need for evidence on effectiveness, benefit, and harm of antidepressants during pregnancy to guide clinical practice.
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