Impact of pregnancy on antidepressant treatment course: a population-based comparative cohort study in France
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ORIGINAL ARTICLE
Impact of pregnancy on antidepressant treatment course: a population-based comparative cohort study in France Anne Bénard-Laribière 1 & Elodie Pambrun 1 & Anne-Laure Sutter-Dallay 1,2 & Sophie Gautier 3 & Caroline Hurault-Delarue 4 & Christine Damase-Michel 4 & Isabelle Lacroix 4 & Antoine Pariente 1,5 Received: 14 August 2019 / Accepted: 7 April 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract The prevention of relapses and the treatment of depression during pregnancy are difficult challenges. The maintenance of antidepressants in pregnancy with its concomitant risks to mother and child needs to be weighed against those associated with not treating the disease. This study aimed at quantifying the impact of the occurrence of pregnancy on the course of antidepressant treatment among newly treated women (< 6 months). We performed a comparative observational cohort study using the nationwide French reimbursement healthcare system database. Women who conceived in 2014 and initiated an antidepressant at any time in the 6 months before pregnancy were compared with nonpregnant women newly exposed to antidepressants with matching on age, antidepressant exposure, history of psychiatric disorders, and area of residence. The primary outcome was a composite of antidepressant discontinuation, switch to another antidepressant, and concomitant use of antidepressants. The secondary outcome was the resumption of antidepressant during follow-up. We used Cox marginal proportional hazards models to compare time to outcomes between pregnant and nonpregnant women. The pregnant cohort included 6593 women, and the comparison cohort 29,347 nonpregnant women. In the period following the first month of treatment, pregnant women were more likely to experience treatment modification, and especially to stop receiving it, compared with nonpregnant women (adjusted hazard ratio (aHR) 1.58; 95%CI, 1.51–1.62). Pregnant women who discontinued treatment had a 41% decreased incidence of antidepressant resumption compared with nonpregnant women (aHR 0.59; 95%CI, 0.56–0.62). Pregnancy was a determinant of antidepressant treatment modification, and especially of discontinuation. Keywords Antidepressive agents . Drug utilization . Insurance health reimbursement . Pharmacoepidemiology . Pregnancy . Cohort studies
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00737-020-01033-z) contains supplementary material, which is available to authorized users. * Anne Bénard-Laribière [email protected] 1
Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, F-33000 Bordeaux, France
2
Charles Perrens Hospital, F-33000 Bordeaux, France
3
Clinical Pharmacology Department, U 1171 University Hospital of Lille, University of Lille, F-59000 Lille, France
4
Clinical Pharmacology Department, INSERM UMR 1027, CIC INSERM 1436, Faculty of Medicine, University Hospital of Toulouse, F-31000 Toulouse, France
5
Clinical Pharm
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