Prenatal care and patterns of antidepressant use during pregnancy: Impact on selected congenital heart defects Restricted; Files & ToC

Simeone, Regina (Fall 2021)

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Women with chronic conditions face increased complications and relapse of their condition during pregnancy. Chronic conditions may impact the timing of entry into prenatal care. Additionally, women are at risk of discontinuing medications when they become pregnant, due to concerns for fetal safety, including the development of congenital heart defects (CHD). However, the impact of prenatal care on antidepressant use during pregnancy, and the risk of CHD among those with different patterns of antidepressant use is unknown. This dissertation explored entry into prenatal care, its relationship with early pregnancy antidepressant use, and CHD risk among women with different patterns of antidepressant use.

In aim 1, we identified women with and without chronic conditions and assessed differences in delayed entry into prenatal care (entry after the first trimester). Overall, 13% of women reported delayed entry into prenatal care, and 18% reported a chronic condition. Women with thyroid conditions were less likely to report delayed entry (prevalence odds ratio [OR], 95% confidence interval [CI]: 0.5 [0.3, 0.9]), but women with hematologic and respiratory conditions were more likely to report delayed entry (ORs: 2.0 [1.0, 3.8] and 1.3 [1.0, 1.7], respectively), compared to those without chronic conditions.

In aim 2, we investigated antidepressant use before and during pregnancy among pre-pregnancy and first trimester antidepressant users. Antidepressant discontinuation before and during the first trimester was common (35% of pregnancies). First trimester prenatal care was associated with increased prevalence of first trimester discontinuation of desvenlafaxine (adjusted prevalence ratio [aPR]: 1.5, 95% CI: 1.0, 2.3) and nortriptyline (aPR: 2.2, 95% CI: 1.3, 3.8).

In aim 3, we assessed whether continuous use, first trimester discontinuation, and pre-pregnancy discontinuation of antidepressants was associated with CHD compared to no antidepressant exposure. Continuous use of any antidepressant was not associated with any CHD (OR: 1.1, 95% CI: 1.0, 1.3). Women who discontinued their antidepressants pre-pregnancy or during the first trimester had similar risk as the unexposed (ORpre: 1.0, 95% CI: 0.8, 1.2; ORfirst: 0.9, 95% CI: 0.8, 1,1).

The findings from this dissertation can inform counseling about prenatal care and the relative safety of antidepressant use during pregnancy.

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