The effect of regulatory advisories on maternal antidepressant prescribing, 1995-2007

An interrupted time series study of 228,876 pregnancies

William V Bobo, Richard A. Epstein, Rachel M. Hayes, Richard C. Shelton, Tina V. Hartert, Ed Mitchel, Jeff Horner, Pingsheng Wu

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

The purpose of this study was to assess whether antidepressant prescribing during pregnancy decreased following release of U.S. and Canadian public health advisory warnings about the risk of perinatal complications with antidepressants. We analyzed data from 228,876 singleton pregnancies among women (aged 15-44 years) continuously enrolled in Tennessee Medicaid with full pharmacy benefits (1995-2007). Antidepressant prescribing was determined through outpatient pharmacy dispensing files. Information on sociodemographic and clinical factors was obtained from enrollment files and linked birth certificates. An interrupted time series design with segmented regression analysis was used to quantify the impact of the advisory warnings (2002-2005). Antidepressant prescribing rates increased steadily from 1995 to 2001, followed by sharper increases from 2002 to late 2004. Overall antidepressant prescribing prevalence was 34.51 prescriptions [95 % confidence interval (CI) 33.37-35.65] per 1,000 women in January 2002, and increased at a rate of 0.46 (95 % CI 0.41-0.52) prescriptions per 1,000 women per month until the end of the pre-warning period (May 2004). During the post-warning period (October 2004-June 2005), antidepressant prescribing decreased by 1.48 (95 % CI 1.62-1.35) prescriptions per 1,000 women per month. These trends were observed for both selective serotonin reuptake inhibitors (SSRI) and non-SSRI antidepressants, although SSRI prescribing decreased at a greater rate. We conclude that antidepressant prescribing to pregnant women in Tennessee Medicaid increased from 1995 to late 2004. U.S. and Canadian public health advisories about antidepressant-associated perinatal complications were associated with steady decreases in antidepressant prescribing from late 2004 until the end of the study period, suggesting that the advisory warnings were impactful on antidepressant prescribing in pregnancy.

Original languageEnglish (US)
Pages (from-to)17-26
Number of pages10
JournalArchives of Women's Mental Health
Volume17
Issue number1
DOIs
StatePublished - Feb 2014

Fingerprint

Antidepressive Agents
Mothers
Pregnancy
Serotonin Uptake Inhibitors
Prescriptions
Medicaid
Confidence Intervals
Interrupted Time Series Analysis
Public Health
Birth Certificates
Pregnant Women
Outpatients
Regression Analysis

Keywords

  • Antidepressants
  • Practice patterns
  • Pregnancy
  • Pregnant women
  • Selective serotonin reuptake inhibitors
  • Trends

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Obstetrics and Gynecology

Cite this

The effect of regulatory advisories on maternal antidepressant prescribing, 1995-2007 : An interrupted time series study of 228,876 pregnancies. / Bobo, William V; Epstein, Richard A.; Hayes, Rachel M.; Shelton, Richard C.; Hartert, Tina V.; Mitchel, Ed; Horner, Jeff; Wu, Pingsheng.

In: Archives of Women's Mental Health, Vol. 17, No. 1, 02.2014, p. 17-26.

Research output: Contribution to journalArticle

Bobo, William V ; Epstein, Richard A. ; Hayes, Rachel M. ; Shelton, Richard C. ; Hartert, Tina V. ; Mitchel, Ed ; Horner, Jeff ; Wu, Pingsheng. / The effect of regulatory advisories on maternal antidepressant prescribing, 1995-2007 : An interrupted time series study of 228,876 pregnancies. In: Archives of Women's Mental Health. 2014 ; Vol. 17, No. 1. pp. 17-26.
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abstract = "The purpose of this study was to assess whether antidepressant prescribing during pregnancy decreased following release of U.S. and Canadian public health advisory warnings about the risk of perinatal complications with antidepressants. We analyzed data from 228,876 singleton pregnancies among women (aged 15-44 years) continuously enrolled in Tennessee Medicaid with full pharmacy benefits (1995-2007). Antidepressant prescribing was determined through outpatient pharmacy dispensing files. Information on sociodemographic and clinical factors was obtained from enrollment files and linked birth certificates. An interrupted time series design with segmented regression analysis was used to quantify the impact of the advisory warnings (2002-2005). Antidepressant prescribing rates increased steadily from 1995 to 2001, followed by sharper increases from 2002 to late 2004. Overall antidepressant prescribing prevalence was 34.51 prescriptions [95 {\%} confidence interval (CI) 33.37-35.65] per 1,000 women in January 2002, and increased at a rate of 0.46 (95 {\%} CI 0.41-0.52) prescriptions per 1,000 women per month until the end of the pre-warning period (May 2004). During the post-warning period (October 2004-June 2005), antidepressant prescribing decreased by 1.48 (95 {\%} CI 1.62-1.35) prescriptions per 1,000 women per month. These trends were observed for both selective serotonin reuptake inhibitors (SSRI) and non-SSRI antidepressants, although SSRI prescribing decreased at a greater rate. We conclude that antidepressant prescribing to pregnant women in Tennessee Medicaid increased from 1995 to late 2004. U.S. and Canadian public health advisories about antidepressant-associated perinatal complications were associated with steady decreases in antidepressant prescribing from late 2004 until the end of the study period, suggesting that the advisory warnings were impactful on antidepressant prescribing in pregnancy.",
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