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Impact of Prenatal Exposure to Antidepressants on Adverse Birth and Pregnancy Outcomes: A Propensity Scored Matched Retrospective Cohort Study (2012-2021)

Alyami, Fatimah
http://orcid.org/0000-0002-7366-4989
http://rave.ohiolink.edu/etdc/view?acc_num=ucin166861847086504

Abstract Details

2022, PhD, University of Cincinnati, Pharmacy: Pharmaceutical Sciences.
Background In the United States, mental health disorders affect 1 in 5 pregnant women each year. The use of antidepressant drugs to treat mental health disorders during pregnancy is a controversial issue. This has drawn attention to the potential impact of antidepressants on pregnancy and fetus development. Objective The objectives of the study are; (I) to describe the utilization of antidepressants in pregnant women diagnosed with mental health disorders, (II) to determine the impact of prenatal exposure to antidepressants on the risk of adverse birth outcomes, (III) to assess the effect of exposure trimester of antidepressants on the risk of adverse birth outcomes, and (IV) to describe the most reported pregnancy adverse events (AEs) related to antidepressants use during pregnancy as reported in FDA Adverse Event Reporting System (FAERS) database. Methods We conducted a propensity score matched, retrospective cohort study using University of Cincinnati Medical Center Hospitals Electronic Medical Records (EMR) from 2012 to 2021. The study cohort consisted of two cohorts. One cohort consisted of pregnant women diagnosed with mental health disorders and exposed to antidepressants during pregnancy. The second cohort consisted of pregnant women diagnosed with mental health disorders, without antidepressant exposure during their pregnancy (reference group). Adverse birth outcomes were identified in the EMR using International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) codes. Moreover, the exposure to antidepressant was assessed in each trimester (1st, 2nd and 3rd) during the pregnancy to examine the impact of trimester exposure on adverse birth outcomes. Generalized estimating equation (GEE) model and multivariable logistic regression were used. Finally, we described the most reported pregnancy adverse events (AEs) related to antidepressant as reported in FAERS database. Results A total of 3573 mothers were identified after applying 1:2 propensity score matching (PSM). Of those, 1191 were antidepressant users and 2382 were nonusers. The odds ratios for the association of antidepressant use and adverse outcomes ranged from 0.33 (95% CI: 0.08-1.49) for persistent pulmonary hypertension to 1.44 (95% CI: 0.82-2.52) for ectopic pregnancy. The multivariate odds ratio for all adverse pregnancy outcomes for antidepressant users was a modest 7% higher compared to nonusers (OR=1.07, 95% CI: 0.97-1.20); however, these data do not provide statistically significant evidence for the association of antidepressant use and adverse pregnancy outcomes. Antidepressant use was associated with 17% lower odds of neonatal outcomes (OR= 0.83, 95% CI: 0.71-0.97). The total number of antidepressant prescriptions among pregnant women was 4000 using UC health EMR. Selective serotonin reuptake inhibitors (SSRIs) was the most prescribed antidepressant class accounting for 73.42% of antidepressant prescriptions. Conclusion Prenatal exposure to antidepressants was not significantly associated with an increase in the odds of having adverse birth or pregnancy outcomes such as preterm delivery and abortion. Furthermore, the relationship between exposure to antidepressants and pregnancy-related outcomes did not vary according to trimester of exposure. Finally, the analysis of FAERS data showed that SSRIs were the most prescribed and had the largest number (10291, [63%]) of pregnancy related AEs compared to other classes of antidepressants.
Jianfei (Jeff) Guo, Ph.D. (Committee Member)
Pamela Heaton, Ph.D. (Committee Member)
Patricia Wigle, Pharm.D. (Committee Member)
Marepalli Rao, Ph.D. (Committee Member)
Ana Hincapie, Ph.D. (Committee Member)
126 p.
Pharmaceuticals
Pregnancy; Antidepressants; Mental disorders; Birth outcomes; Adverse events; Malformations

Recommended Citations

Citations

  • Alyami, F. (2022). Impact of Prenatal Exposure to Antidepressants on Adverse Birth and Pregnancy Outcomes: A Propensity Scored Matched Retrospective Cohort Study (2012-2021) [Doctoral dissertation, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin166861847086504

    APA Style (7th edition)

  • Alyami, Fatimah. Impact of Prenatal Exposure to Antidepressants on Adverse Birth and Pregnancy Outcomes: A Propensity Scored Matched Retrospective Cohort Study (2012-2021). 2022. University of Cincinnati, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin166861847086504.

    MLA Style (8th edition)

  • Alyami, Fatimah. "Impact of Prenatal Exposure to Antidepressants on Adverse Birth and Pregnancy Outcomes: A Propensity Scored Matched Retrospective Cohort Study (2012-2021)." Doctoral dissertation, University of Cincinnati, 2022. http://rave.ohiolink.edu/etdc/view?acc_num=ucin166861847086504

    Chicago Manual of Style (17th edition)

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This open access ETD is published by University of Cincinnati and OhioLINK.