A Cohort Study of Psychotropic Prescription Drug Use in Pregnancy in British Columbia, Canada from 1997 to 2010

Prevalence of the Prescribing of Attention-Deficit Hyperactivity Disorder Medication During Pregnancy: A Systematic Review

Attention deficit hyperactivity disorder (ADHD) diagnosis in women has markedly increased in recent years, resulting in an increase of ADHD medication exposure during pregnancy, which has uncertain health risks. It is therefore critical to understand the extent of the issue. The objective of this novel systematic review was to investigate the prevalence of the prescribing of ADHD medication during pregnancy. A systematic review was conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The last search was October 13, 2023, for articles examining the prescribing of ADHD medication in pregnancy. Fifteen studies were included. Participants from the United States (n = 4), the Nordic countries (n = 10), Canada (n = 3), and Australia (n = 1) were included. The prevalence of ADHD-medication dispensing during pregnancy ranged from 0.07 to 6.01 per 1,000 pregnancies. Typically, stimulant medications were more prevalent than nonstimulants. The most prevalent ADHD medication dispensed during pregnancy was methylphenidate followed by amphetamine-type medications. There was high heterogeneity (I2 = 99.95%) between the studies, making the study data not appropriate for meta-analysis. The prevalence of the prescribing of ADHD medications in pregnancy ranged substantially, with psychostimulant medications most prescribed. Apart from in the Nordic countries, estimates of prevalence were limited.

Effect of Benzodiazepines and Z-Drug Medications During Antenatal and Postnatal Depression and Anxiety: A Systematic Review and Meta-Analysis

BACKGROUND

Benzodiazepines (BZD) and Z-drugs are often prescribed for alleviating such symptoms and treating maternal psychiatric disorders and epilepsy. However, their use is limited due to the apprehensions and risks related to poor maternal and neonatal outcomes.

OBJECTIVE

This meta-analysis evaluated the rationality and efficacy of using Benzodiazepines and Z-drugs for managing anxiety and depression in pregnant women.

METHODS

The meta-analysis was based on a systematic review through keyword search utilizing Scopus, Pubmed, and Cochrane databases. One hundred three articles were deemed eligible, but only 21 articles were selected for the meta-analysis.

RESULTS

The meta-analysis showed that despite the indication for anxiety and depression in pregnant women, the usage of BZD and Z-drugs was significantly low compared to other psychotropic medications, with no therapy or non-pharmacological interventions. Our study shows that, during the antenatal and postnatal period, women required more anti-depressants, anti-psychotics, and anxiolytic drugs.

CONCLUSION

Although BZDs and Z-drugs are effective in managing insomnia during peripartum and post-partum, they are either ineffective or contraindicated for managing anxiety and depression in pregnant women compared to anxiolytics and anti-depressants.

Drug exposure during pregnancy in primary care: an algorithm and observational study from SIDIAP database, Catalunya, Spain

OBJECTIVES

To develop an algorithm to identify pregnancy episodes in women at childbearing age using SIDIAP (Information System for the Improvement of Research in Primary Care) data (Catalunya, Spain).To describe drugs dispensed during gestation.

DESIGN

Construction of an algorithm to identify all pregnancy episodes occurred from January 2011 to June 2020 in women aged 12-50. The variables used to create the algorithm include first day of last menstrual period, reasons for pregnancy termination and diagnoses registered in the primary healthcare records. Population-based cohort study including the pregnancy episodes identified by the algorithm.

SETTING

Catalonia, Spain.

PARTICIPANTS

All women aged 12-50 with at least one pregnancy episode occurred during January 2011-June 2020.

INTERVENTIONS

No interventions performed.

PRIMARY AND SECONDARY OUTCOME MEASURES

Identification of pregnancy episodes through an algorithm and description of drug exposure.

RESULTS

We identified 327 865 pregnancy episodes in 250 910 people with a mean age of 31.3 years. During the study period, 83.4% of the episodes were exposed to at least one drug. The most frequent groups dispensed were iron preparations (48% of pregnancy episodes), iodine therapy (40.2%), analgesics and antipyretics (28%), penicillins (19.8%), vitamin B12 plus folic acid (19.7%) and non-steroidal anti-inflammatory drugs (NSAIDs, 15.1%). The supplements were more frequently dispensed at least twice, and the drugs for acute conditions were mainly dispensed only once during the pregnancy episode.

CONCLUSIONS

We developed an algorithm to automatically identify the pregnancy periods in SIDIAP.We described prescription drugs used during pregnancy. The most used ones were supplements, analgesics, NSAID or antibiotics.SIDIAP might be an efficient database to study drug safety during pregnancy and the consequences of drug use in the offspring.

TRIAL REGISTRATION NUMBER

EUPAS37675.

Prenatal exposure to benzodiazepines and Z-drugs in humans and risk of adverse neurodevelopmental outcomes in offspring: A systematic review

When used during pregnancy, benzodiazepines (BZDs) and related z-drugs could pass readily through the placenta and the foetal blood-brain barrier, where they can bind to γ-amino butyric acid (GABA) receptors in the developing foetal brain. Yet, data on long-term safety of prenatal BZD and z-drug use and its impact on offspring neurodevelopment are inconclusive. In this systematic review, we qualitatively synthetize the existing evidence on maternal exposure to various BZDs and z-drugs during pregnancy and offspring cognitive, emotional, behavioural, and motor skills developmental outcomes. Nineteen studies were included. We used harvest plots to visualize the directions of reported associations. Despite several associations between distinct types of BZDs and z-drugs and an increased risk of outcomes within different neurodevelopmental domains were observed, a remarkable scarcity of overall research on the topic and considerable discrepancies in methodology, particularly towards controlling for confounding by indication, precluded drawing conclusions with a reasonable degree of certainty. We outline various research strategies to mitigate methodological limitations and provide directions for future empirical studies on the topic.

Current Issues within the Perinatal Mental Health Care System in Aichi Prefecture, Japan: A Cross-Sectional Questionnaire Survey

Mental illnesses commonly occur in the reproductive age. This study aimed to identify the issues that exist within the perinatal mental health care system. A cross-sectional survey was conducted in Aichi Prefecture in central Japan. Questionnaires on the situation between 2016 and 2018 were mailed to the head physicians of 128 maternity care units, 21 neonatal intensive care units (NICUs), and 40 assisted reproductive technology (ART) units. A total of 82 (52.6 per 100,000 births) women were admitted to mental health care units during the perinatal period, and 158 (1.0 per 1000 births) neonates born to mothers with mental illness were admitted to NICUs. Approximately 40% of patients were hospitalized in psychiatric hospitals without maternity care units. Eighty-four (71.1%) and 76 (64.4%) maternity care units did not have psychiatrists or social workers, respectively. Moreover, 20–35% of the head physicians in private clinics, general hospitals, and ART units endorsed the discontinuation of psychotropic drug use during pregnancy. However, the corresponding figures were only 5% among those in maternal-fetal centers. Resources for perinatal mental illness might be limited. Perspectives on psychotropic drug use differed based on the type of facilities where the doctors were working.