title: Selective serotonin reuptake inhibitor prescribing before, during and after pregnancy: a population-based study in six European regions.
abstract: OBJECTIVE
  To explore the prescribing patterns of selective serotonin reuptake inhibitors (SSRIs) before, during and after pregnancy in six European population-based databases.
  
  
  METHODS
  Descriptive drug utilisation study.
  
  
  METHODS
  Six electronic healthcare databases in Denmark, the Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK.
  
  
  METHODS
  All women with a pregnancy ending in a live or stillbirth starting and ending between 2004 and 2010.
  
  
  METHODS
  A common protocol was implemented across databases to identify SSRI prescriptions issued (UK) or dispensed (non-UK) in the year before, during or in the year following pregnancy.
  
  
  METHODS
  The percentage of deliveries in which the woman received an SSRI prescription in the year before, during or in the year following pregnancy. We also compared the choice of SSRIs and changes in prescribing over the study period.
  
  
  RESULTS
  In total, 721 632 women and 862,943 deliveries were identified. In the year preceding pregnancy, the prevalence of SSRI prescribing was highest in Wales [9.6%; 95% confidence interval (CI95 ), 9.4-9.8%] and lowest in Emilia Romagna (3.3%; CI95 , 3.2-3.4%). During pregnancy, SSRI prescribing had dropped to between 1.2% (CI95 , 1.1-1.3%) in Emilia Romagna and 4.5% (CI95 , 4.3-4.6%) in Wales. The higher UK pre-pregnancy prescribing rates resulted in higher first trimester exposures. After pregnancy, SSRI prescribing increased most rapidly in the UK. Paroxetine was more commonly prescribed in the Netherlands and Italian regions than in Denmark and the UK.
  
  
  CONCLUSIONS
  The higher SSRI prescribing rates in the UK, compared with other European regions, raise questions about differences in the prevalence and severity of depression and its management in pregnancy across Europe.
authors.affiliation: Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Charlton
authors.affiliation: Department of Nursing, College of Human and Health Sciences, Swansea University, Swansea, UK.
authors.forename: S
authors.initials: S
authors.lastname: Jordan
authors.affiliation: Institute of Clinical Physiology - National Research Council (IFC-CNR), Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pierini
authors.affiliation: Paediatric Department, Hospital Lillebaelt, Kolding, Denmark.
authors.forename: E
authors.initials: E
authors.lastname: Garne
authors.affiliation: IMER (Emilia Romagna Registry of Birth Defects), Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy.
authors.forename: A J
authors.initials: AJ
authors.lastname: Neville
authors.affiliation: Paediatric Department, Hospital Lillebaelt, Kolding, Denmark.
authors.forename: A V
authors.initials: AV
authors.lastname: Hansen
authors.affiliation: Agenzia Regionale di Sanità Della Toscana, Florence, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Gini
authors.affiliation: Centre for Health Information, Research and Evaluation, Swansea University, Swansea, UK.
authors.forename: D
authors.initials: D
authors.lastname: Thayer
authors.affiliation: Centre for Health Information, Research and Evaluation, Swansea University, Swansea, UK.
authors.forename: K
authors.initials: K
authors.lastname: Tingay
authors.affiliation: Drug Policy Service, Emilia Romagna Region Health Authority, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Puccini
authors.affiliation: Pharmacoepidemiology and Pharmacoeconomics Unit, Department of Pharmacy, University of Groningen, Groningen, the Netherlands.
authors.forename: H J
authors.initials: HJ
authors.lastname: Bos
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: A M
authors.initials: AM
authors.lastname: Nybo Andersen
authors.affiliation: Maternal, Fetal and Infant Research Centre, University of Ulster, Ulster, UK.
authors.forename: M
authors.initials: M
authors.lastname: Sinclair
authors.affiliation: Institute of Nursing, University of Ulster, Ulster, UK.
authors.forename: H
authors.initials: H
authors.lastname: Dolk
authors.affiliation: Pharmacoepidemiology and Pharmacoeconomics Unit, Department of Pharmacy, University of Groningen, Groningen, the Netherlands.
authors.forename: L T W
authors.initials: LT
authors.lastname: de Jong-van den Berg
mesh_terms: D000328:Adult; D003718:Denmark / Q000453:epidemiology; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000453:epidemiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: Drug utilisation; electronic health records; pregnancy; serotonin uptake inhibitors