Maternal antidepressant use and adverse outcomes: a cohort study of 228,876 pregnancies.
OBJECTIVE
The purpose of this study was to describe antidepressant medication use patterns during pregnancy and pregnancy outcomes.


METHODS
We evaluated a cohort of 228,876 singleton pregnancies that were covered by Tennessee Medicaid, 1995-2007.


RESULTS
Of 23,280 pregnant women with antidepressant prescriptions before pregnancy, 75% of them filled none in the second or third trimesters of pregnancy, and 10.7% of them used antidepressants throughout pregnancy. Filling 1, 2, and ≥3 antidepressant prescriptions during the second trimester was associated with shortened gestational age by 1.7 (95% confidence interval [CI], 1.2-2.3), 3.7 (95% CI, 2.8-4.6), and 4.9 (95% CI, 3.9-5.8) days, when controlled for measured confounders. Third-trimester selective serotonin reuptake inhibitor use was associated with infant convulsions; adjusted odds ratios were 1.4 (95% CI, 0.7-2.8); 2.8 (95% CI, 1.9-5.5); and 4.9 (95% CI, 2.6-9.5) for filling 1, 2, and ≥3 prescriptions, respectively.


CONCLUSIONS
Most women discontinue antidepressant medications before or during the first trimester of pregnancy. Second-trimester antidepressant use is associated with preterm birth, and third-trimester selective serotonin reuptake inhibitor use is associated with infant convulsions.
Informatics Center, School of Medicine, Vanderbilt University, Nashville, TN, USA.
Rachel M
RM
Hayes
Pingsheng
P
Wu
Richard C
RC
Shelton
William O
WO
Cooper
William D
WD
Dupont
Ed
E
Mitchel
Tina V
TV
Hartert
D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D003863:Depression / Q000188:drug therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016015:Logistic Models; D008484:Medicaid; D015999:Multivariate Analysis; D007752:Obstetric Labor, Premature / Q000139:chemically induced; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000139:chemically induced; D012127:Respiratory Distress Syndrome, Newborn / Q000139:chemically induced; D012189:Retrospective Studies; D012640:Seizures / Q000139:chemically induced; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D013714:Tennessee; D014481:United States
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors