Département de Médecine Générale, UFR de Médicine, Université Clermont Auvergne, Clermont-Ferrand, France.
CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Observatoire Français des Médicaments Antalgiques (OFMA), Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France.
Br J Clin Pharmacol. 2021 Mar;87(3):965-987. doi: 10.1111/bcp.14449. Epub 2020 Aug 4.
The aim of this study was to monitor the trajectories of antidepressant use during pregnancy and the postpartum period among women chronically treated with antidepressants before their pregnancy, and to assess characteristics associated with each trajectory.
This cohort study included all pregnant women whose data were included in the General Sample of Beneficiaries (EGB) database affiliated with the French Health Insurance System, from 2009 to 2014. Women were followed up until 6 months after childbirth. Chronic treatment was defined as exposure over the 6-month period preceding pregnancy. A group-based trajectory model (GBMT) was estimated to identify distinctive longitudinal profiles of antidepressant use.
Among 760 women chronically treated with antidepressants before their pregnancy, 55.8% stopped their treatment permanently in the first trimester, 20.4% discontinued it for a minimum of 3 months and resumed it postpartum, and 23.8% maintained it throughout pregnancy and postpartum. No sociodemographic or medical characteristics were associated with any trajectory group. Women who maintained treatment presented more frequent obstetric complications and postpartum psychiatric disorders. Among women who interrupted treatment, prescription of benzodiazepines and anxiolytics decreased initially but rose postpartum to a higher level than before pregnancy.
Pregnant women treated with antidepressant require a re-evaluation of psychiatric treatment. It is necessary to pay attention to obstetric complications for severely depressed women. Additionally, as relapse was associated with increased benzodiazepine use, it is important to carefully monitor all women who stop antidepressant treatment during pregnancy.
本研究旨在监测在怀孕期间和产后期间长期接受抗抑郁药物治疗的女性使用抗抑郁药物的轨迹，并评估与每种轨迹相关的特征。
本队列研究包括了所有在 2009 年至 2014 年期间纳入法国健康保险系统附属的一般受益人群（EGB）数据库中的孕妇数据。女性随访至产后 6 个月。慢性治疗定义为在怀孕前的 6 个月内暴露。采用基于群组的轨迹模型（GBMT）来识别抗抑郁药物使用的不同纵向特征。
在 760 名在怀孕期间长期接受抗抑郁药物治疗的女性中，55.8%在孕早期永久性停止治疗，20.4%至少停止 3 个月并在产后恢复治疗，23.8%在整个怀孕期间和产后继续治疗。没有社会人口学或医疗特征与任何轨迹组相关。维持治疗的女性出现更多的产科并发症和产后精神障碍。中断治疗的女性，苯二氮䓬类和抗焦虑药物的处方最初减少，但产后增加到比怀孕前更高的水平。
接受抗抑郁药物治疗的孕妇需要重新评估精神科治疗。对于重度抑郁的女性，需要注意产科并发症。此外，由于复发与苯二氮䓬类药物使用增加相关，因此，仔细监测所有在怀孕期间停止抗抑郁药物治疗的女性非常重要。
