(A23) Utilization patterns of Antidepressants in pregnant women: An interrupted time series analysis

Publication Number: 306

Background: Depression is highly prevalent among pregnant women, making the use of antidepressants a crucial issue. However, both untreated depression and use of antidepressant were associated with adverse perinatal outcomes, which highlights the importance of surveillance on antidepressant use during pregnancy.

Objectives: This study has two aims. First, from the national level, we aimed to investigate the annual trends of antidepressant use among pregnant women in Taiwan. Second, from the individual level, we assessed the dynamic changes in antidepressant use through pregnancy using interrupted time series analysis (ITSA).

Methods: A nationwide cohort study was conducted using Taiwan’s National Health Insurance Research Database (NHIRD) and National Birth Certificate Application (BCA) from 2004 to 2018. Pregnancies with a gestational age of 20-42 weeks were included, and prescriptions for antidepressants during that period were captured. In the first part of the study, the temporal trends of antidepressant use during pregnancy were reported annually, and further stratified by age. In the second part of the study, the utilization patterns of antidepressants before, during (specifically, in the first, second, and third trimesters), and after pregnancy were evaluated by ITSA. Segmented regression analysis was adopted to assess the level and trend changes of antidepressant uses across different stages of pregnancy.

Results: Of 2,930,988 pregnancies, 21421 (0.7%) received at least one antidepressant prescription during pregnancy, with a rising trend in use over time (0.5% in 2004 to 1.0% in 2018) from the national level. While the highest prevalence of antidepressant use (1.0%) was found among pregnant women aged 35 years and over, such prevalence was comparable among those aged 25-34 years and under 25 years. From the individual level, the ITSA further revealed distinct patterns of antidepressant use across different stages of pregnancy, with a significant decrease in the first trimester (level change -0.23%, 95% CI -0.25 to -0.21; trend change -0.02, 95% CI -0.02 to -0.02) and a notable increase postpartum (level change -0.06%, 95% CI 0.04 to 0.08; trend change 0.02, 95% CI 0.02 to 0.02).

Conclusions: From the national level, we found an increase trend of maternal antidepressant use from 2004 to 2018. From the individual level, our study showed a sudden decrease in antidepressant use during the first trimester and an increase in postpartum, which reflects pregnant women’s concerns regarding the potential adverse effects. These findings emphasize the importance of research in this field to optimize antidepressant uses during pregnancy.