Monday, June 19, 2017

Study of Pregnant Publicly Insured Women Finds Increase in SGA Use

The use of second-generation antipsychotics (SGAs) by pregnant women enrolled in Medicaid rose more than threefold between 2001 and 2010, according to a report in Psychiatric Services in Advance. In contrast, the proportion of women who received first-generation antipsychotics (FGA) remained stable over the 10-year period.

“To help clinicians and patients make informed treatment decisions, there is an urgent need for further studies in this area to examine adverse pregnancy outcomes associated with maternal use of antipsychotics, in monotherapy or polytherapy, as well as studies examining comparative effectiveness of specific antipsychotic agents among pregnant women,” Yoonyoung Park, Sc.D., of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital in Boston and colleagues wrote.

Park and colleagues analyzed Medicaid Analytic eXtract (MAX) data (2001–2010) from 1,522,247 pregnancies. MAX contains data on demographic characteristics, hospitalizations, and outpatient visits as well as on medications dispensed by an outpatient pharmacy.

From 2001 to 2010, the number of women who filled at least one prescription for a SGA during pregnancy increased from .4% (n=376) to 1.3% (n=2,044) (p<.001), while the use of FGAs remained stable at about .1%.

The increase in the proportion of women taking SGAs appeared to be driven in part by an increase in quetiapine use, which rose from 0.1% in 2001 to 0.6% in 2010, and aripiprazole, which was introduced in 2002 and was used by 0.4% of women by 2010, the authors noted. 

During the study period, the prevalence of bipolar disorder diagnosis in pregnant women also increased more than threefold (from .7% to 2.5%), while the proportion of pregnant women with bipolar disorder who received antipsychotics increased from 13.6% in 2001 to 23.6% by 2010. The authors noted that the increase in bipolar disorder diagnoses is “consistent with the increase observed for the general population, including children and adolescents.”

Additionally, among the 15,196 women who took antipsychotics at any time during pregnancy, 65.2% also received antidepressants, 24.9% received benzodiazepines, and 22.0% received mood stabilizers; 765 women (5%) received at least one prescription for all four of these drug types at some point during pregnancy.

“Polytherapy with other psychotropic medications, common in this population, deserves more attention with regard to fetal safety,” Park and colleagues wrote. “Because Medicaid pays for close to 50% of all deliveries of babies in the United States, the results reflect the real-world utilization of antipsychotics in a large proportion of pregnant women in the U.S. population.” 

For related information, see the Psychiatric News article “Yes or No: Prescribing Antidepressants to Pregnant Patients,” by Jennifer L. Payne, M.D. 



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