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Medications with Potential for Fetal Risk Prescribed to Veterans.

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Women veterans often use medications, including antidepressants, during pregnancy. Many discontinue these vital treatments, highlighting a need for better care coordination and pre-pregnancy counseling for medication management.

Keywords:
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Area of Science:

  • Reproductive Health
  • Pharmacology
  • Military Medicine

Background:

  • Women service members face high rates of trauma, often leading to pharmacological treatment.
  • Pregnancy management for Veterans Health Administration (VHA) patients typically occurs outside the VHA.
  • Understanding medication use during pregnancy for this population is crucial for maternal and infant outcomes.

Purpose of the Study:

  • To examine medication exposures among women veterans during preconception, pregnancy, and postpartum periods.
  • To assess factors associated with the use of selective serotonin reuptake inhibitors (SSRIs)/serotonin norepinephrine reuptake inhibitors (SNRIs) and potentially risky drugs during pregnancy.
  • To identify predictors for the discontinuation of these medications from prepregnancy to pregnancy.

Main Methods:

  • Utilized data from the Center for Maternal and Infant Outcomes Research in Translation (COMFORT) study (2015-2021).
  • Collected primary survey data and linked secondary VHA healthcare data.
  • Analyzed medication fills and covariates for three 9-month periods using multiple regression.

Main Results:

  • During pregnancy, 36% of women had pain disorders, 19% major depression, and 18% PTSD.
  • SSRI/SNRI antidepressant use dropped from 36% preconception to 26% during pregnancy; 15% discontinued these medications.
  • Comorbidity predicted overall medication use, while depression predicted SSRI/SNRI discontinuation; no predictors for risky drug discontinuation were found.

Conclusions:

  • Women veterans were prescribed multiple medications during pregnancy, with a concerning rate of antidepressant discontinuation.
  • Improved pre-pregnancy counseling on medication use is essential for veterans of childbearing potential.
  • Enhanced information sharing between VHA providers and non-VHA obstetricians is critical for optimizing medication management and outcomes.