Selective serotonin reuptake inhibitor prescribing before, during and after pregnancy: a population-based study in six European regions

Objective To explore the prescribing patterns of selective
serotonin reuptake inhibitors (SSRIs) before, during and after
pregnancy in six European population-based databases.
Design Descriptive drug utilisation study.
Setting Six electronic healthcare databases in Denmark, the
Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest
of the UK.
Population All women with a pregnancy ending in a live or
stillbirth starting and ending between 2004 and 2010.
Methods A common protocol was implemented across databases
to identify SSRI prescriptions issued (UK) or dispensed
(non-UK) in the year before, during or in the year following
pregnancy.
Main outcome measures The percentage of deliveries in which
the woman received an SSRI prescription in the year before,
during or in the year following pregnancy. We also compared
the choice of SSRIs and changes in prescribing over the study
period.
Results In total, 721 632 women and 862 943 deliveries were
identified. In the year preceding pregnancy, the prevalence of
SSRI prescribing was highest in Wales [9.6%; 95% confidence
interval (CI95), 9.4-9.8%] and lowest in Emilia Romagna (3.3%;
CI95, 3.2-3.4%). During pregnancy, SSRI prescribing had
dropped to between 1.2% (CI95, 1.1-1.3%) in Emilia Romagna
and 4.5% (CI95, 4.3-4.6%) in Wales. The higher UK
pre-pregnancy prescribing rates resulted in higher first trimester
exposures. After pregnancy, SSRI prescribing increased most
rapidly in the UK. Paroxetine was more commonly prescribed in
the Netherlands and Italian regions than in Denmark and the
UK.
Conclusions The higher SSRI prescribing rates in the UK,
compared with other European regions, raise questions about
differences in the prevalence and severity of depression and its
management in pregnancy across Europe.