Antidepressant use patterns and foregone perinatal healthcare in Switzerland: Results from the MAMA cohort

Affective disorders are prevalent during pregnancy, and they impact health-seeking patterns. Antidepressants are a common treatment for these conditions, but prenatal antidepressant discontinuation is frequent. We investigated if antidepressant use patterns were associated with increased foregone routine prenatal ultrasound (primary outcome) and foregone postnatal examination (secondary outcome).

We used health insurance data from 2010 to 2019. We identified pregnancies resulting in delivery among women covered during four pre-pregnancy trimesters (T_-4 to T_-1), pregnancy trimesters (T₁ to T₃), and 90-day postpartum. We defined four patterns of antidepressant dispensation in the exposed group: continuation, discontinuation (at T₁), early discontinuation (at T_-1), and restart. The exposed group was compared to a comparison group without any psychoactive medication (note: diagnoses of mental disorders were unmeasured). Generalized estimating equation models including maternal age, year and women's identity were performed to compare patterns regarding foregone prenatal ultrasound and postnatal examinations.

Among 69,938 pregnancies, 1430 were dispensed antidepressants at T_-1. Of these, 267 continued antidepressants, 300 discontinued after T₁, 728 discontinued before T₁ and 135 restarted before delivery. Women forewent prenatal ultrasound in 18.6 % of the exposed group (vs. 13.2 % in the comparison group) and they forewent postnatal examination in 26.6 % (vs. 21.4 %). The only pattern with a significant association with foregone prenatal ultrasound was restart (proportion = 77.0 %, aOR = 22.43, 95 % CI = [15.00, 33.53], p < .001).

The difference between restart and the entire sample in foregone ultrasounds (77.0 % vs. 13.3 %) suggested that badly-timed antidepressant discontinuation may be associated with increased foregone healthcare.