Key result
Among pregnant women with pre-existing OCD, continuing antidepressant treatment during pregnancy was not associated with a significantly different probability of a postpartum visit for OCD compared to discontinuing treatment before pregnancy (HR 1.34, 95% CI 0.69-2.62).
Why the study?
The association between antidepressant continuation during pregnancy and postpartum mental health in women with obsessive-compulsive disorder is uncertain.
Does antidepressant continuation during pregnancy prevent postpartum visits for OCD or mood/anxiety disorders in pregnant women with pre-existing OCD?
Cohort (n=1,317)
Does antidepressant continuation during pregnancy prevent postpartum visits for OCD or mood/anxiety disorders in pregnant women with pre-existing OCD?
Antidepressant continuation during pregnancy in women with pre-existing OCD was not associated with an increased risk of postpartum OCD or mood/anxiety disorder visits compared to discontinuation, though partial continuation (single fill) increased risk.
The association between antidepressant continuation during pregnancy and postpartum mental health in women with obsessive-compulsive disorder (OCD) is uncertain. We identified 1317 women with live-birth singleton pregnancies and having outpatient/inpatient visits for OCD in the 4 years pre-pregnancy from the Danish registries. We defined three groups based on antidepressant prescriptions filled in the 2 years before pregnancy to delivery: (i) unexposed (n = 449); (ii) discontinuers (n = 346), i.e., with pre-pregnancy antidepressant fills only; (iii) continuers (n = 522), i.e., with antidepressant fills before and during pregnancy. We estimated crude and propensity score weighted hazard ratio (HRs) of postpartum visit for OCD and mood/anxiety disorders using Cox proportional hazard models. In weighted analyses, we found no difference in the probability of a postpartum visit for OCD or MADs with antidepressant continuation compared to unexposed and discontinuers. The likelihood of a postpartum OCD visit was higher in pregnancies having only one prescription fill during pregnancy compared to unexposed (HR = 3.44, 95% CI: 1.24, 9.54) or discontinuers (HR = 2.49, 95% CI: 0.91, 6.83). Continuers in pregnancy without antidepressant fill in the first three months postpartum had higher probability for postpartum visit for mood/anxiety disorders compared to discontinuers (HR = 3.84, 95% CI: 1.49, 9.92). Among pregnant women with pre-existing OCD, we found similar probabilities of a postpartum visit for OCD or mood/anxiety disorders in antidepressant continuers compared to unexposed and discontinuers. Continuers with a single prescription fill during pregnancy or no fill postpartum may have higher risks for these outcomes. Our findings highlight the importance of continuity of treatment throughout the perinatal period.
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Trinh et al. (2023) conducted a cohort in Pre-existing obsessive-compulsive disorder (OCD) (n=1,317). Antidepressant continuation during pregnancy vs. Antidepressant discontinuation before pregnancy (and unexposed) was evaluated on Postpartum visit for obsessive-compulsive disorder (OCD) (HR 1.34, 95% CI 0.69-2.62). Among pregnant women with pre-existing OCD, continuing antidepressant treatment during pregnancy was not associated with a significantly different probability of a postpartum visit for OCD compared to discontinuing treatment before pregnancy (HR 1.34, 95% CI 0.69-2.62).
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