Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA.
Gen Hosp Psychiatry. 2013 May-Jun;35(3):265-71. doi: 10.1016/j.genhosppsych.2012.12.010. Epub 2013 Jan 30.
The risk of depression in women is greatest at childbearing age. We sought to examine and explain national trends in antidepressant use in pregnant women.
This was a cohort study including pregnant women aged 12-55 who were enrolled in Medicaid during 2000-2007. We examined the proportion of women taking antidepressants during pregnancy by patient characteristics (descriptive), by region (mixed-effects model) and over time (interrupted time series).
We identified 1,106,757 pregnancies in 47 states; mean age was 23 years, and 60% were nonwhite. Nearly 1 in 12 used an antidepressant during pregnancy. Use was higher for older (11.2% for age ≥30 vs. 7.6% for <30) and white (14.4% vs. 4.0% for nonwhite) women. There was a four- to fivefold difference in rate of antidepressant use among states. Of the 5.3% of women taking antidepressants at conception, 33% and 17% were still on treatment 90 and 180 days, respectively, into pregnancy; an additional 4% began use during pregnancy. Labeled pregnancy-related health advisories did not appear to affect antidepressant use.
Antidepressant use during pregnancy remains high in this population; treatment patterns vary substantially by patient characteristics and region. Comparative safety and effectiveness data to help inform treatment choices are needed in this setting.
女性在生育年龄患抑郁症的风险最大。我们试图研究和解释孕妇使用抗抑郁药的全国趋势，并对其进行解释。
这是一项队列研究，纳入了 2000 年至 2007 年期间参加医疗补助计划的 12-55 岁孕妇。我们通过患者特征（描述性）、地区（混合效应模型）和时间（中断时间序列）来检查怀孕期间服用抗抑郁药的女性比例。
我们在 47 个州确定了 1106757 例妊娠；平均年龄为 23 岁，60%为非白人。近 1/12 的孕妇在怀孕期间使用了抗抑郁药。年龄较大（年龄≥30 岁的为 11.2%，年龄<30 岁的为 7.6%）和白人（14.4%比非白人的 4.0%）的女性使用抗抑郁药的比例更高。各州之间抗抑郁药使用率差异为四到五倍。在开始妊娠时服用抗抑郁药的 5.3%的女性中，分别有 33%和 17%在妊娠 90 和 180 天时仍在接受治疗，另有 4%在妊娠期间开始使用。与妊娠相关的药物标签警示似乎并未影响抗抑郁药的使用。
在这一人群中，怀孕期间仍有较高比例的女性使用抗抑郁药；治疗模式因患者特征和地区而异。在这种情况下，需要比较安全性和有效性数据来帮助指导治疗选择。
