Antidepressant Prescription Medication Use Patterns among Insured, Low Income Pregnant Women

Despite of the controversy of antidepressant use during the gestational period, the reported antidepressant use at any time during pregnancy has increased. Our study assessed antidepressant prescription medication use patterns during pregnancy among insured, low-income women in the United States. This retrospective study used South Carolina Medicaid claims data (2004-2009). Included were pregnant women (≥ 18 years) with single or multiparous live birth(s) with a diagnosis for major depression or reported pharmacy claims for antidepressant prescriptions 1 year before becoming pregnant or while pregnant. Antidepressant prevalence prior to and during pregnancy, type of antidepressant, and trimester when the antidepressant use started, characterized antidepressant prescription use patterns. Among 24,077 pregnant women with live births, the prevalence of antidepressant use before becoming pregnant and during pregnancy was 5.5% and 6% respectively. A total of 3,237 pregnant women met inclusion criteria. Of the 1,456 women prescribed antidepressants during pregnancy, 16% showed a history of major depression predating their pregnancy and 67% initiated antidepressant medications after becoming pregnant. Nearly 80% took selective serotonin reuptake inhibitors (SSRIs) during pregnancy, and 32% initiated antidepressants during the first trimester. Age, race, and preexisting depression were associated with antidepressant use. In pregnant, insured low-income women, the majority prescribed antidepressants were new users. Pharmacologic treatment for pregnant women with depressive symptoms, particularly in newly diagnosed major depression remains challenging.