Department of Psychiatry and Psychology, The Mayo Clinic, Rochester, MN, USA,
Arch Womens Ment Health. 2014 Feb;17(1):17-26. doi: 10.1007/s00737-013-0383-6. Epub 2013 Oct 3.
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.
这项研究的目的是评估在美国和加拿大发布有关抗抑郁药与围产期并发症风险的公共卫生咨询警告后，怀孕期间抗抑郁药的处方是否减少。我们分析了 1995 年至 2007 年期间田纳西州医疗补助计划中连续入组的 228876 名 15-44 岁女性的单胎妊娠数据（年龄）。通过门诊药房配药档案确定抗抑郁药的开具情况。社会人口统计学和临床因素的信息来自入组档案和链接的出生证明。采用截断时间序列设计和分段回归分析来量化咨询警告（2002-2005 年）的影响。抗抑郁药的开具率从 1995 年稳步上升到 2001 年，随后从 2002 年到 2004 年底急剧上升。2002 年 1 月，每 1000 名女性的总体抗抑郁药开具率为 34.51 剂（95%置信区间（CI）为 33.37-35.65），并且以每月每 1000 名女性增加 0.46 剂（95%CI 为 0.41-0.52）的速度增加，直到预警期结束（2004 年 5 月）。在预警后期间（2004 年 10 月至 2005 年 6 月），每 1000 名女性的抗抑郁药开具量每月减少 1.48 剂（95%CI 为 1.62-1.35）。这些趋势既适用于选择性 5-羟色胺再摄取抑制剂（SSRIs），也适用于非 SSRIs 抗抑郁药，尽管 SSRIs 的开具速度更快。我们得出的结论是，田纳西州医疗补助计划中孕妇的抗抑郁药开具量从 1995 年增加到 2004 年底。美国和加拿大有关抗抑郁药与围产期并发症相关的公共卫生咨询警告与 2004 年底至研究结束期间抗抑郁药开具量的稳步下降有关，这表明咨询警告对抗抑郁药在怀孕期间的开具具有影响。
