Selective serotonin reuptake inhibitor prescribing before, during and after pregnancy: a population-based study in six European regions
Selective serotonin reuptake inhibitor prescribing before, during and after pregnancy: a population-based study in six European regions
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DOI：
10.1111/1471-0528.13143
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发表时间：
2015-06-01
影响因子：
5.8
通讯作者：
de Jong-van den Berg, L. T. W.
中科院分区：
文献类型：
--
作者：
Charlton, R. A.;Jordan, S.;de Jong-van den Berg, L. T. W.
目的在6个欧洲人群数据库中探索孕前、孕中和孕后选择性5-羟色胺再摄取抑制剂(SSRI)的处方模式。设计描述性药物利用研究。在丹麦、荷兰、意大利(Emily Romagna/Tuscany)、威尔士和英国其他地区建立6个电子医疗数据库。人口从2004-2010年间所有怀孕以活产或死产结束的妇女。方法通过一个通用的数据库，确定在怀孕前一年、怀孕期间或怀孕后一年发放(英国)或分发(非英国)SSRI处方。主要结果衡量妇女在怀孕前一年、怀孕期间或怀孕后一年获得SSRI处方的分娩百分比怀孕期间或怀孕后的第二年。我们还比较了在研究期间SSRI的选择和处方的变化。结果总共确定了721632名妇女和862943名分娩。在怀孕前一年，威尔士的SSRI处方的流行率最高[9.6%；95%可信区间(CI95)，9.4-9.8%]，而埃米莉亚·罗马尼亚最低(3.3%；CI95，3.2-3.4%)。在怀孕期间，SSRI处方在埃米莉亚·罗马尼亚下降到1.2%(CI95，1.1-1.3%)，在威尔士下降到4.5%(CI95，4.3-4.6%)。英国较高的孕前处方率导致了较高的妊娠早期暴露。怀孕后，SSRI处方在英国增长最快。在荷兰和意大利地区，帕罗西汀的处方比在丹麦和英国更常见。结论与其他欧洲地区相比，英国的SSRI处方率较高，这引发了欧洲各地怀孕期间抑郁症的患病率和严重程度及其管理方面的差异的问题。
ObjectiveTo explore the prescribing patterns of selective serotonin reuptake inhibitors (SSRIs) before, during and after pregnancy in six European population-based databases.DesignDescriptive drug utilisation study.SettingSix electronic healthcare databases in Denmark, the Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK.PopulationAll women with a pregnancy ending in a live or stillbirth starting and ending between 2004 and 2010.MethodsA common protocol was implemented across databases to identify SSRI prescriptions issued (UK) or dispensed (non-UK) in the year before, during or in the year following pregnancy.Main outcome measuresThe percentage of deliveries in which the woman received an SSRI prescription in the year before, during or in the year following pregnancy. We also compared the choice of SSRIs and changes in prescribing over the study period.ResultsIn total, 721 632 women and 862943 deliveries were identified. In the year preceding pregnancy, the prevalence of SSRI prescribing was highest in Wales [9.6%; 95% confidence interval (CI95), 9.4-9.8%] and lowest in Emilia Romagna (3.3%; CI95, 3.2-3.4%). During pregnancy, SSRI prescribing had dropped to between 1.2% (CI95, 1.1-1.3%) in Emilia Romagna and 4.5% (CI95, 4.3-4.6%) in Wales. The higher UK pre-pregnancy prescribing rates resulted in higher first trimester exposures. After pregnancy, SSRI prescribing increased most rapidly in the UK. Paroxetine was more commonly prescribed in the Netherlands and Italian regions than in Denmark and the UK.ConclusionsThe higher SSRI prescribing rates in the UK, compared with other European regions, raise questions about differences in the prevalence and severity of depression and its management in pregnancy across Europe.