(277) Maternal Mental Health in Focus: Real-World Data on Antidepressant Use. A Cohort Study in Catalonia.

Background: Affective disorders, notably depression, are prevalent among women of childbearing age, with pregnancy often exacerbating symptoms. Antidepressant drug use has been associated with increased congenital malformation risks and other neonatal health consequences, necessitating well risk benefit ratio balance treatment decisions. Adherence to antidepressant treatment during pregnancy has been barely studied.

Objectives: To characterize the prescriptions, adherence and persistence to antidepressants within a cohort of pregnant women using electronic health records (EHR) from Catalonia (SIDIAP).

Design: Drug-utilization cohort study covering the period from January 2011 to June 2020. The study included pregnancy episodes identified by the algorithm created within this database.

Setting: Data were retrieved from the Information System for the Development of Research in Primary Care (SIDIAP), a comprehensive EHR repository.

Participants: Women aged 12-50 with at least one pregnancy episode occurred during January 2011-June 2020 with a prescription of an antidepressant.

Primary and secondary outcomes: Primary outcomes included antidepressant exposure considering prescriptions and claims, which were estimated through prevalence and primary adherence in pregnancy episodes and by trimester. We also assessed prescriptions overtime, comedication, restart of medication after pregnancy and persistence to antidepressant treatment over pregnancy. Secondary outcomes involved health conditions, outcome of pregnancies, smoking habits, and socioeconomic characteristics.

Results: We identified a total of 99,605 pregnancies, of which 14.87% were prescribed antidepressants (14.815 pregnancies, 13.556 women). Of those, 5.69% collected their medication from the pharmacy. Pregnancies with a prescription of antidepressants had a median duration of 38.4 weeks (IQR: 25.2, 40). The median age at pregnancy was 33.46 years (IQR: 29.2, 37.1). Health conditions analysis highlighted anxiety as the most frequent medical condition. Paroxetine was the most prescribed antidepressant over time. However, sertraline showed a monthly rise over the observation period. Prevalence of antidepressants prescriptions and primary adherence showed a decline during pregnancy and increased again during the postpartum period. At least 12.49% of pregnancies had a concomitant prescription of another type of antidepressant. Reintroduction rate after pregnancy reaches a 29,18% (CI 95%:27.76- 30.64). Those women who were prescribed antidepressants during pregnancy (incident users) were more persistent than those who had the prescription before.

Conclusions: Regulatory authorities can enhance patient-centred prescription practices based on clinical safety post-authorisation studies, such as the present one. We highlight the need of addressing disparities in peripartum depression management due to the lack of consistent, high-quality Clinical Practice Guidelines in Europe. We underscore the need to advocate for a primary care system that adequately addresses the psychological needs of patients, as well as the provision of sufficient resources to provide appropriate care and follow-up to patients.