ABSTRACT
OBJECTIVE: The risk of depression in women is greatest at childbearing age. We sought to examine and explain national trends in antidepressant use in pregnant women. METHODS: This was a cohort study including pregnant women aged 12-55 who were enrolled in Medicaid during 2000-2007. We examined the proportion of women taking antidepressants during pregnancy by patient characteristics (descriptive), by region (mixed-effects model) and over time (interrupted time series). RESULTS: We identified 1,106,757 pregnancies in 47 states; mean age was 23 years, and 60% were nonwhite. Nearly 1 in 12 used an antidepressant during pregnancy. Use was higher for older (11.2% for age ≥30 vs. 7.6% for <30) and white (14.4% vs. 4.0% for nonwhite) women. There was a four- to fivefold difference in rate of antidepressant use among states. Of the 5.3% of women taking antidepressants at conception, 33% and 17% were still on treatment 90 and 180 days, respectively, into pregnancy; an additional 4% began use during pregnancy. Labeled pregnancy-related health advisories did not appear to affect antidepressant use. CONCLUSIONS: Antidepressant use during pregnancy remains high in this population; treatment patterns vary substantially by patient characteristics and region. Comparative safety and effectiveness data to help inform treatment choices are needed in this setting.