title: National trends in antidepressant medication treatment among publicly insured pregnant women.
abstract: OBJECTIVE
  The risk of depression in women is greatest at childbearing age. We sought to examine and explain national trends in antidepressant use in pregnant women.
  
  
  METHODS
  This was a cohort study including pregnant women aged 12-55 who were enrolled in Medicaid during 2000-2007. We examined the proportion of women taking antidepressants during pregnancy by patient characteristics (descriptive), by region (mixed-effects model) and over time (interrupted time series).
  
  
  RESULTS
  We identified 1,106,757 pregnancies in 47 states; mean age was 23 years, and 60% were nonwhite. Nearly 1 in 12 used an antidepressant during pregnancy. Use was higher for older (11.2% for age ≥30 vs. 7.6% for <30) and white (14.4% vs. 4.0% for nonwhite) women. There was a four- to fivefold difference in rate of antidepressant use among states. Of the 5.3% of women taking antidepressants at conception, 33% and 17% were still on treatment 90 and 180 days, respectively, into pregnancy; an additional 4% began use during pregnancy. Labeled pregnancy-related health advisories did not appear to affect antidepressant use.
  
  
  CONCLUSIONS
  Antidepressant use during pregnancy remains high in this population; treatment patterns vary substantially by patient characteristics and region. Comparative safety and effectiveness data to help inform treatment choices are needed in this setting.
authors: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA. khuybrechts@partners.org
authors: Krista F
authors: KF
authors: Huybrechts
authors: Kristin
authors: K
authors: Palmsten
authors: Helen
authors: H
authors: Mogun
authors: Mary
authors: M
authors: Kowal
authors: Jerry
authors: J
authors: Avorn
authors: Soko
authors: S
authors: Setoguchi-Iwata
authors: Sonia
authors: S
authors: Hernández-Díaz
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D003866:Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008484:Medicaid; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D014481:United States; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
references: Am J Obstet Gynecol. 2011 Jul;205(1):51.e1-8
references: 21514558
references: N Engl J Med. 2011 Oct 27;365(17):1605-11
references: 22029982
references: Can J Clin Pharmacol. 2003 Summer;10(2):67-71
references: 12879144
references: Am J Psychiatry. 1994 Jul;151(7):979-86
references: 8010383
references: Matern Child Health J. 2006 Mar;10(2):127-38
references: 16400535
references: J Clin Pharm Ther. 2002 Aug;27(4):299-309
references: 12174032
references: Gen Hosp Psychiatry. 2009 Sep-Oct;31(5):403-13
references: 19703633
references: Infant Behav Dev. 2006 Jul;29(3):445-55
references: 17138297
references: N Engl J Med. 2006 Feb 9;354(6):579-87
references: 16467545
references: Birth Defects Res B Dev Reprod Toxicol. 2007 Feb;80(1):18-27
references: 17187388
references: Arch Pediatr Adolesc Med. 2004 Apr;158(4):312-6
references: 15066868
references: Psychiatr Serv. 2011 Oct;62(10):1159-66
references: 21969642
references: JAMA. 2002 Jan 16;287(3):337-44
references: 11790213
references: Am J Obstet Gynecol. 2006 Apr;194(4):961-6
references: 16580283
references: Arch Gen Psychiatry. 2006 Aug;63(8):898-906
references: 16894066
references: J Am Acad Child Adolesc Psychiatry. 2007 Jun;46(6):737-746
references: 17513986
references: J Am Acad Child Adolesc Psychiatry. 2006 Feb;45(2):223-230
references: 16429093
references: Pharmacoepidemiol Drug Saf. 2007 Oct;16(10):1086-94
references: 17729378
references: Clin Drug Investig. 2012 Feb 1;32(2):139-44
references: 22220929
references: Epidemiology. 2006 Nov;17(6):701-4
references: 17028507
references: Pharmacoepidemiol Drug Saf. 2007 Oct;16(10):1075-85
references: 17729379
references: N Engl J Med. 1996 Oct 3;335(14):1010-5
references: 8793924
references: N Engl J Med. 2010 Dec 9;363(24):2320-31
references: 21142534
references: JAMA. 2006 Feb 1;295(5):499-507
references: 16449615
references: Arch Pediatr Adolesc Med. 2002 Nov;156(11):1129-32
references: 12413342
references: Am J Epidemiol. 2008 Mar 15;167(6):633-40
references: 18194999
references: Am J Epidemiol. 1995 Nov 15;142(10):1103-12
references: 7485055
references: N Engl J Med. 2007 Jun 28;356(26):2684-92
references: 17596602
references: Am J Obstet Gynecol. 2008 Feb;198(2):194.e1-5
references: 17905176
references: JAMA. 1997 Jan 22-29;277(4):333-40
references: 9002497
references: Am J Psychiatry. 2007 Oct;164(10):1515-20
references: 17898342
references: BMJ. 2001 Aug 4;323(7307):257-60
references: 11485953
references: J Clin Epidemiol. 1994 Feb;47(2):165-71
references: 8113825
references: Am J Obstet Gynecol. 2007 Jun;196(6):544.e1-5
references: 17547888
references: N Engl J Med. 2007 Jun 28;356(26):2675-83
references: 17596601
references: Can J Psychiatry. 2004 Nov;49(11):726-35
references: 15633850
references: J Clin Epidemiol. 2000 Dec;53(12):1248-57
references: 11146272