Impact of Prenatal Exposure to Antidepressants on Adverse Birth and Pregnancy Outcomes: A Propensity-Scored Matched Retrospective Cohort Study Using a Large Electronic Medical Record Database 2012-2021
Author(s)
Fatimah Alyami, BPharm, MS, PhD1, Pam Heaton, BSPharm, FAPhA, PhD2, Ana L. Hincapie, MS, PhD3, Marepalli B Rao, MS, PhD4, Patricia Wigle, Pharm.D., BCPS, BCACP, FCCP3, Jeff Jianfei Guo, B.Pharm, PhD3.
1Center for Health Technology Assessment, Riyadh, Saudi Arabia, 2College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USA, 3James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA, 4Division of Environmental & Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
1Center for Health Technology Assessment, Riyadh, Saudi Arabia, 2College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USA, 3James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA, 4Division of Environmental & Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
OBJECTIVES: In the United States, mental health disorders affect 1 in 5 pregnant women each year. This has drawn the attention of healthcare practitioners to the potential impact of antidepressants on pregnancy and fetus development. The study aims to explore the utilization of antidepressants in pregnant women diagnosed with mental health disorders and to determine the impact of prenatal exposure to antidepressants on the risk of adverse birth outcomes.
METHODS: A propensity score matched, retrospective cohort study using University of Cincinnati Medical Center Hospitals Electronic Medical Records (EMR) from 2012 to 2021. The study consisted of two cohorts. One cohort included pregnant women diagnosed with mental health disorders and exposed to antidepressants during pregnancy. The second cohort consisted of pregnant women diagnosed with mental health disorders, without antidepressant exposure during their pregnancy. Generalized estimating equation (GEE) model and multivariable logistic regression were used.
RESULTS: A total of 3,573 mothers were identified after applying 1:2 propensity score matching (PSM). Of those, 1,191 were antidepressant users and 2,382 were non-users. The odds ratios for the association of antidepressant use and adverse outcomes ranged from 0.33 (95% CI: 0.08-1.49) for persistent pulmonary hypertension to 1.44 (95% CI: 0.82-2.52) for ectopic pregnancy. The multivariate odds ratio for all adverse pregnancy outcomes for antidepressant users was 7% higher compared to non-users (OR=1.07, 95% CI: 0.97-1.20). Antidepressant use was associated with 17% lower odds of neonatal adverse outcomes (OR= 0.83, 95% CI: 0.71-0.97). The total number of antidepressant prescriptions among pregnant women was 4,000 using University of Cincinnati Health UC Health EMR. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed class, accounting for 73.42% of antidepressant prescriptions.
CONCLUSIONS: Prenatal exposure to antidepressants was not significantly associated with an increase in the odds of adverse birth or pregnancy outcomes such as preterm delivery and abortion.
METHODS: A propensity score matched, retrospective cohort study using University of Cincinnati Medical Center Hospitals Electronic Medical Records (EMR) from 2012 to 2021. The study consisted of two cohorts. One cohort included pregnant women diagnosed with mental health disorders and exposed to antidepressants during pregnancy. The second cohort consisted of pregnant women diagnosed with mental health disorders, without antidepressant exposure during their pregnancy. Generalized estimating equation (GEE) model and multivariable logistic regression were used.
RESULTS: A total of 3,573 mothers were identified after applying 1:2 propensity score matching (PSM). Of those, 1,191 were antidepressant users and 2,382 were non-users. The odds ratios for the association of antidepressant use and adverse outcomes ranged from 0.33 (95% CI: 0.08-1.49) for persistent pulmonary hypertension to 1.44 (95% CI: 0.82-2.52) for ectopic pregnancy. The multivariate odds ratio for all adverse pregnancy outcomes for antidepressant users was 7% higher compared to non-users (OR=1.07, 95% CI: 0.97-1.20). Antidepressant use was associated with 17% lower odds of neonatal adverse outcomes (OR= 0.83, 95% CI: 0.71-0.97). The total number of antidepressant prescriptions among pregnant women was 4,000 using University of Cincinnati Health UC Health EMR. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed class, accounting for 73.42% of antidepressant prescriptions.
CONCLUSIONS: Prenatal exposure to antidepressants was not significantly associated with an increase in the odds of adverse birth or pregnancy outcomes such as preterm delivery and abortion.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO141
Topic
Clinical Outcomes, Epidemiology & Public Health, Real World Data & Information Systems
Disease
Mental Health (including addition), No Additional Disease & Conditions/Specialized Treatment Areas