Self-reported perinatal depressive symptoms and postnatal symptom severity after treatment with antidepressants in pregnancy: a cross-sectional study across 12 European countries using the Edinburgh Postnatal Depression Scale
Received 8 November 2017
Accepted for publication 16 February 2018
Published 6 June 2018 Volume 2018:10 Pages 655—669
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Ms Justinn Cochran
Peer reviewer comments 3
Editor who approved publication: Professor Irene Petersen
Angela Lupattelli,1 Michael J Twigg,2 Ksenia Zagorodnikova,3 Myla E Moretti,4 Mariola Drozd,5 Alice Panchaud,6,7 Andre Rieutord,8 Romana Gjergja Juraski,9 Marina Odalovic,10 Debra Kennedy,11,12 Gorazd Rudolf,13 Herbert Juch,14 Hedvig Nordeng1,15
1PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy and PharmaTox Strategic Research Initiative, University of Oslo, Oslo, Norway; 2School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK; 3Northwest Medical Center for Drug Safety in Pregnancy and Lactation, Northwest State Medical University named after I. I. Mechnikov, St. Petersburg, Russia; 4Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, ON, Canada; 5Department of Applied Pharmacy, Medical University of Lublin, Lublin, Poland; 6School of Pharmaceutical Sciences, University of Geneva and Lausanne, Geneva, Switzerland; 7Division of Clinical Pharmacology and Swiss Teratogen Information Service, Lausanne University Hospital, Lausanne, Switzerland; 8Pharmacy Service, Hospital Antoine-Béclère, GH HUPS, APHP, Clamart France and Européenne de Formation pour les Pharmaciens, Clamart, France; 9Children’s Hospital Srebrnjak, Medical School of Osijek, Josip Juraj Strossmayer University, Osijek, Croatia; 10Faculty of Pharmacy, University of Belgrade, Beograd, Serbia; 11MotherSafe, Royal Hospital for Women, Sydney, NSW, Australia; 12School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia; 13Clinical Institute of Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia; 14Cell Biology, Histology and Embryology, Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Medical University Graz, Graz, Austria; 15Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
Purpose: This study aimed at exploring the prevalence of self-reported antenatal and postnatal depressive symptoms by severity across multiple countries and the association between antidepressant treatment in pregnancy and postnatal symptom severity.
Materials and methods: This was a multinational web-based study conducted across 12 European countries (n=8069). Uniform data collection was ensured via an electronic questionnaire. Pregnant women at any gestational week and mothers of children with <1 year of age could participate. We used the Edinburgh Postnatal Depression Scale (EPDS) to measure the prevalence of antenatal and postnatal depressive symptoms according to severity, which were corrected by survey weight adjustment (descriptive analysis). Within mothers with a psychiatric disorder (n=173), we estimated the association between antidepressant treatment in pregnancy and postnatal depressive symptom severity, as standardized EPDS mean scores, via the inverse probability of treatment weight (association analysis).
Results: In the descriptive analysis (n=8069), the period prevalence of moderate-to-very severe depressive symptoms was higher in the western and eastern regions relative to the northern region, both in the antenatal period (6.8%–7.5% vs 4.3%) and in the postnatal period (7.6% vs 4.7%). One in two mothers with psychiatric disorders used an antidepressant in pregnancy (86 of 173). In the association analysis, women medicated at any time during pregnancy (adjusted β=−0.34, 95% confidence interval [CI] =−0.66, −0.02) had a significant postnatal symptom severity reduction compared with the nonmedicated counterpart. This effect was larger (β=−0.74, 95% CI =−1.24, −0.24) when the analysis was restricted to mothers within 6 months after childbirth.
Conclusion: The prevalence of self-reported antenatal and postnatal depressive symptoms differs across European countries. Among women with psychiatric disorders, those who had been on treatment with antidepressants during pregnancy were less likely to report postnatal depressive symptoms, particularly within the 6-month period after childbirth, compared with the nonmedicated counterpart.
Keywords: antidepressants, pharmacotherapy, pregnancy and postpartum, depression, anxiety, web-based
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