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Use of antidepressants by low-income pregnant women has jumped more than twofold, raising questions about fetal risks

A new study, supported in part by the Agency for Healthcare Research and Quality (HS10384), reveals a more than twofold jump in use of antidepressants among low-income pregnant women who were insured by Tennessee Medicaid (TennCare). The rise was mostly due to use of the new selective serotonin reuptake inhibitors (SSRIs), which were used by 10 percent of the women studied by 2003. The use of SSRIs during both early and late pregnancy has been linked to neonatal problems such as neurological and cardiovascular abnormalities. Thus, increased use of SSRIs among pregnant women raises concerns about fetal risks. It also underscores the urgent need for studies on these risks, explain researchers at the Vanderbilt Center for Education and Research on Therapeutics.

Researchers linked the pharmacy records of 105,335 pregnant women enrolled in TennCare from 1999-2003 to birth certificates. The proportion of pregnant women using antidepressants increased from 5.7 percent of pregnancies in 1999 to 13.4 percent in 2003, after adjustment for maternal age, race, parity, and other factors. This was largely due to greater use of SSRIs, which more than tripled from 2.9 percent of pregnancies in 1999 to 10.2 percent in 2003. Use of non-SSRIs increased as well, but to a lesser extent.

Overall, the 13.3 percent of pregnant women taking antidepressants in 2003 would translate nationally to about 180,000 fetuses exposed to antidepressants in the United States that year. For women giving birth in 2003, 10 percent took antidepressants during the first trimester, 6.4 percent during the second, and 5.9 percent during the third. Women older than 25 years, who were white, and had more than a high school education, were more likely to take an antidepressant during pregnancy. The most commonly prescribed antidepressants included sertraline (2.1 percent of pregnancies), paroxetine (1.9 percent), and fluoxetine (1.9 percent).

This study may not be generalizable to other populations, given that the women studied were low-income, urban, young, and often teenage mothers.

See "Increasing use of antidepressants in pregnancy," by William O. Cooper, M.D., M.P.H., Mary E. Willy, Ph.D., Stephen J. Pont, M.D., and Wayne A. Ray, Ph.D., in the June 2007 American Journal of Obstetrics & Gynecology 196(6), pp. 544e1-544e5.

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