(269) Comparison of antidepressant use in normal-age and late-age pregnancies

Background: Antidepressants are among the most commonly used drugs during pregnancy. Nonetheless, existing knowledge on the potential effects of fetal exposure to the drug, maternal age and other risk factors remains scarce.

Objectives: We aimed to compare the teratogenicity risk assessment reports on antidepressant use from a tertiary healthcare center according to the age groups of pregnant women.

Methods: Between January 2012 and December 2023, we retrospectively examined the teratogenicity risk assessment reports issued by Marmara University Teratology Information Service to pregnant women for antidepressant use. Characteristics of the cases, including maternal age, the antidepressants used and gestational week were evaluated. Results of the teratogenicity risk assesment reports were examined in three categories (Category 1: No increase in risk, category 2: Particular attention regarding benefit/risk or dose adjustment advised, category 3: Drug use should be avoided due to potential risk, or treatment course should be revised). The findings were compared based on the age of the pregnant, as normal-age (18-34 years) and late-age (35-50 years).

Results: Among the 365 cases consulted during the twelve-year study period, the mean age was 32.3±5.4 years, of which 35.9% were late-age pregnancies. The average gestational week was 10.0±5.7 and 74.5% of the cases were in the first trimester. The majority of risk assessment reports fell into category 1, comprising 69.3% of the cases. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly encountered antidepressant class in both normal- and late-age groups (69.9% and 59.6%, respectively). Sertraline, escitalopram and paroxetine were top three antidepressants in both groups. The normal-age group exhibited a greater proportion of category 1 reports (73.8% vs. 60.5%, p< 0.05), whereas the late-age group had higher percentage of category 3 reports (19.8% vs. 8.8%, p< 0.05).

Conclusions: This study revealed that the use of antidepressants considered as high-risk during pregnancy was notably prevalent, particularly among the late-age group. The antidepressants encountered in the risk assessment reports, primarily SSRIs, showed similar and different characteristics among normal- and late-age pregnancies. These results underscore the importance of age-specific evaluations while prescribing antidepressants and reporting risk analysis for pregnant women.