UNPLANNED PREGNANCY, DISCONTINUATION OF SSRI AND RISK OF RELAPSE
9 slide(s) – English – 2012-03-06
Near 6% of pregnant women received an antidepressant at the time of conception (Andrade et al, 2008). Many women, and even doctors, suppressing the treatment for fear of birth defects or harming the fetuses. However, discontinuation of antidepressant treatment has been associated with an increased risk of relapse during pregnancy (Cohen et al, 2006). To our knowledge, only one prospective study has assessed the risk of relapse of affective disorders after discontinuation of antidepressants in pregnancy (Cohen et al, 2006) and the factors associated with antidepressant discontinuation are unknown.
The objective of study were described the factors associated to discontinuation of Selective Serotonin Reuptake Inhibitors (SSRI) in pregnant women and the rates of reintroduction of SSRIs throughout pregnancy.
To describe the factors associated to discontinuation of Selective Serotonin Reuptake Inhibitors (SSRI) in pregnant women and the rates of reintroduction of SSRIs throughout pregnancy.
A prospective study was conducted at the Perinatal Psychiatry Program. Total sample was composed by 201 pregnant women with depressive or anxiety disorder (DSM-IV criteria) who received SSRI at the time conception. Clinical and socio-demographic variables were collected at the first visit.We evaluated pregnancy planning with a question (\"This pregnancy has been planned?\") with three possible answers: 1) Yes, it has been planned and well received, 2) No, not planned but it has been well received and 3) No, it was an accident.
At the fisrt visit, depressive symptoms during pregnancy were assessed using the Spanish version of the Edinburgh Postnatal Depression Scale (EPDS), and anxiety symptoms were measured using the State-Trait Anxiety Inventory (STAI-S).
Among the 132 women in the sample, 70 (53%) discontinued treatment with SSRI when they know they are pregnant. Socio-demographic and clinical characteristics did not differ significantly between women who maintain and women who discontinued treatment. Only unplanned pregnancy was associated with major risk of discontinuation treatment (OR 2.7, IC95 1.34-5.52). We compared previous variables between planned and unplanned pregnancy groups. Only the poor partner relationship was significantly associated with unplanned pregnancy (OR = 6.8, 95% CI = 2.16-21.37)
Nearly 57% (n=40) of women who discontinued SSRI reintroduced antidepressant therapy during pregnancy, most of them between first and second trimester. Women who reintroduced medication had higher scores on EPDS and STAI (p<.05).
Unplanned pregnancy was a risk factor for abrupt discontinuation of SSRIs upon confirmation pregnancy in pregnant women with depressive or anxiety disorder. Poor partner relationship was associated with a unplanned pregnancy.
The 57,1% of pregnant women who discontinued treatment with SSRI reintroduced this over pregnancy for relapse. These women had higher EPDS and STAI scores than women who maintained treatment.
Public Health Programs are necessary to decrease the number of unplanned pregnancies in women at risk, specially in women with affective disorders.