HEALTHx2: patient-centered approaches for studying the effectiveness and reproductive safety of antidepressant medication in perinatal women

• Fonseca, Ana; Branquinho, Mariana; Monteiro, Fabiana; Araújo-Pedrosa, Anabela; Bjørndal, Ludvig Daae & Lupattelli, Angela (2023). Treatment options and their uptake among women with symptoms of perinatal depression: exploratory study in Norway and Portugal. BJPsych Open. ISSN 2056-4724. 9(3), p. 1–9. doi: 10.1192/bjo.2023.56. Full text in Research Archive
• Trinh, Nhung; Munk-Olsen, Trine; Wray, Naomi R.; Bergink, Veerle; Nordeng, Hedvig Marie Egeland & Lupattelli, Angela [Show all 7 contributors for this article] (2023). Timing of Antidepressant Discontinuation During Pregnancy and Postpartum Psychiatric Outcomes in Denmark and Norway. JAMA psychiatry. ISSN 2168-6238. 80(5), p. 441–450. doi: 10.1001/jamapsychiatry.2023.0041.
• Tauqeer, Fatima; Moen, Anne; Myhr, Kirsten; Wilson, Claire A. & Lupattelli, Angela (2023). Assessing decisional conflict and challenges in decision-making among perinatal women using or considering using antidepressants during pregnancy—a mixed-methods study. Archives of Women's Mental Health. ISSN 1434-1816. 26, p. 669–683. doi: 10.1007/s00737-023-01341-0. Full text in Research Archive Show summary

  This study aims to investigate decisional conflict and elucidate challenges in decision-making among perinatal women using or considering using antidepressant (AD) during pregnancy. A sequential, mixed-methods study was employed among pregnant and postnatal women in Norway who had been offered ADs in the last 5 years. Quantitative data were obtained through an electronic questionnaire. Decisional conflict in pregnancy was assessed using the Decisional Conflict Scale (DCS) defined as either low (

• Liu, Xiaoqin; Molenaar, Nina; Agerbo, Esben; Momen, Natalie C.; Rommel, Anna-Sophie & Lupattelli, Angela [Show all 8 contributors for this article] (2022). Antidepressant discontinuation before or during pregnancy and risk of psychiatric emergency in Denmark: A population-based propensity score-matched cohort study. PLoS Medicine. ISSN 1549-1277. 19(1). doi: 10.1371/journal.pmed.1003895. Full text in Research Archive
• Trønnes, Johanne Naper; Lupattelli, Angela; Ystrøm, Eivind & Nordeng, Hedvig Marie Egeland (2022). Analysis of Prenatal Exposure to Opioid Analgesics and Scholastic Skills in Children in Fifth Grade in Norway. JAMA Network Open. ISSN 2574-3805. 5(7). doi: 10.1001/jamanetworkopen.2022.22425. Full text in Research Archive
• Trinh, Nhung; Nordeng, Hedvig Marie Egeland; Bandoli, Gretchen; Palmsten, Kristin; Eberhard-Gran, Malin & Lupattelli, Angela (2022). Antidepressant Fill and Dose Trajectories in Pregnant Women with Depression and/or Anxiety: A Norwegian Registry Linkage Study. Clinical Epidemiology. ISSN 1179-1349. 14, p. 1439–1451. doi: 10.2147/CLEP.S379370. Full text in Research Archive
• Trinh, Nhung; Nordeng, Hedvig Marie Egeland; Bandoli, Gretchen; Eberhard-Gran, Malin Marie Cecilia & Lupattelli, Angela (2022). Antidepressant and mental health care utilization in pregnant women with depression and/or anxiety: An interrupted time-series analysis. Journal of Affective Disorders. ISSN 0165-0327. 308, p. 458–465. doi: 10.1016/j.jad.2022.04.101. Full text in Research Archive
• Trinh, Nhung; Semark, Birgitte Dige; Munk-Olsen, Trine; Liu, Xiaoqin; Rø, Øyvind & Bulik, Cynthia M. [Show all 9 contributors for this article] (2022). Psychiatric visits during the postpartum year in women with eating disorders who continue or discontinue antidepressant treatment in pregnancy. International Journal of Eating Disorders. ISSN 0276-3478. 56(3), p. 582–594. doi: 10.1002/eat.23877. Full text in Research Archive
• Bjørndal, Ludvig Daae; Tauqeer, Fatima; Heiervang, Kristin Sverdvik; Clausen, Hanne Kristin; Heitmann, Kristine & Lupattelli, Angela (2022). Perceived risk of neurodevelopmental outcomes in offspring related to psychotropic and mental illness exposures in pregnancy and breastfeeding: a cross-sectional survey of women with past or current mental illness. BMJ Open. ISSN 2044-6055. 12(9), p. 1–11. doi: 10.1136/bmjopen-2022-061159. Full text in Research Archive Show summary

  Objectives: To investigate the perceived risk of psychotropic and mental illness exposures (1) during pregnancy or (2) while breastfeeding on offspring neurodevelopment, and factors associated with this perception in women with past/current mental illness. Design: Cross-sectional, web-based study. Setting: Nationwide in Norway, June 2020-June 2021. Participants: Women aged 18-55 years who were pregnant, recent mothers or planning a pregnancy, and had been offered antidepressants in the last 5 years. Primary and secondary outcome measures: Perceived risk of prenatal and breastmilk exposure to psychotropic medications and maternal mental illness on offspring neurodevelopmental outcomes. Results: We included 448 women: 234 pregnant, 146 mothers and 68 planning a pregnancy. On a 0-10 scale, women perceived antidepressants as least harmful both (1) in pregnancy (mean score 4.2, 95% CI 3.6 to 4.8) and (2) while breastfeeding (mean score 3.8, 95% CI 3.3 to 4.4), relative to antipsychotics, anxiety/sleeping medication or antiepileptics (mean score range: 6.3-6.5 during pregnancy, 5.5-6.2 while breastfeeding). Many participants were unfamiliar with psychotropics other than antidepressants. The perceived risk of mental illness exposure exceeded that of antidepressants (mean score range 5.6-5.9) in both exposure periods. Using general linear models, factors associated with greater antidepressant risk perception in both exposure periods included having lower education, non-Norwegian native language, and employment status (range mean score difference (β): 2.07-6.07). For pregnant women and mothers, there was an inverse association between perceived risk and the perceived antidepressant effectiveness in both exposure periods (range of β: -0.18 to -0.25). Conclusions: In women with past/current mental illness, the perceived risk of antidepressant exposure on child neurodevelopment was lower than that for maternal mental illness. Other psychotropic medications were perceived as more harmful. As medication risk perception influences the decision-making regarding treatment of mental illness, pre- and pregnancy counselling should target women with characteristics associated with higher perceived risk. Keywords: EPIDEMIOLOGY; MENTAL HEALTH; OBSTETRICS; PSYCHIATRY; THERAPEUTICS. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

• Gustavson, Kristin; Ystrøm, Eivind; Ask, Helga; Torvik, Fartein Ask; Hornig, Mady & Susser, Ezra [Show all 16 contributors for this article] (2021). Acetaminophen use during pregnancy and offspring attention deficit hyperactivity disorder - a longitudinal sibling control study. JCPP Advances. ISSN 2692-9384. 1(2). doi: 10.1002/jcv2.12020. Full text in Research Archive
• Tauqeer, Fatima; Wood, Mollie; Andersen, Sarah Hjorth; Lupattelli, Angela & Nordeng, Hedvig (2021). Perinatal use of triptans and other drugs for migraine - A nationwide drug utilization study. PLOS ONE. ISSN 1932-6203. 16(8). doi: 10.1371/journal.pone.0256214. Full text in Research Archive Show summary

  Objective To characterize nationwide utilization patterns of migraine pharmacotherapy before, during, and after pregnancy in women with triptan use. Methods Population-based data were obtained by linking the Medical Birth Registry of Norway and the Norwegian Prescription Database from 2006 to 2017. We included 22,940 pregnancies among 19,669 women with at least one filled triptan prescription, a proxy for migraine, in the year before pregnancy or during pregnancy. The population was classified into four groups: i) continuers; ii) discontinuers; iii) initiators, and vi) post-partum re-initiators. Participant characteristics and prescription fills for other drugs such as analgesics, antinauseants, and preventive drugs among the groups were examined, along with an array of triptan utilization parameters. Results In total, 20.0% of the women were classified as triptan continuers, 54.1% as discontinuers, 8.0% as initiators, and 17.6% as re-initiators. Extended use of triptans (�15 daily drug doses/month) occurred among 6.9% of the continuers in the first trimester. The top 10% of triptan continuers and initiators accounted for 41% (95% CI: 39.2% - 42.5%) and 33% (95% CI: 30.3% - 35.8%) of the triptan volume, respectively. Triptan continuers and initiators had similar patterns of acute co-medication during pregnancy, but use of preventive drugs was more common among the continuers before, during, and after pregnancy. Conclusion Among women using triptans before and during pregnancy, one in four continued triptan treatment during pregnancy, and extended triptan use was relatively low. Triptan discontinuation during and in the year after pregnancy was common. Use of other acute migraine treatments was higher among both continuers and initiators of triptans. Women using preventive migraine treatment were most commonly triptan continuers and re-initiators after pregnancy. Prescribing to and counseling of women with migraine should be tailored to the condition severity and their information needs to promote optimal migraine management in pregnancy. Introduction

• Ilic, Miljana; Nordeng, Hedvig Marie Egeland & Lupattelli, Angela (2021). Medical care contact for infertility and related medication use during pregnancy – a European, cross-sectional web-based study. Norsk Epidemiologi. ISSN 0803-2491. 29(1-2), p. 97–106. doi: 10.5324/nje.v29i1-2.4051. Full text in Research Archive
• Wood, Mollie; Lupattelli, Angela; Palmsten, Kristin; Bandoli, Gretchen; Hurault-Delarue, Caroline & Damase-Michel, Christine [Show all 9 contributors for this article] (2021). Longitudinal Methods for Modeling Exposures in Pharmacoepidemiologic Studies in Pregnancy. Epidemiologic Reviews. ISSN 0193-936X. 43(1), p. 130–146. doi: 10.1093/epirev/mxab002. Full text in Research Archive
• Vallee, Jennifer; Wong, Yih; Mannino, Eline; Nordeng, Hedvig Marie Egeland & Lupattelli, Angela (2020). Association between Antidepressant Treatment during Pregnancy and Postpartum Self-Harm Ideation in Women with Psychiatric Disorders: A Cross-Sectional, Multinational Study. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(1), p. 1–15. doi: 10.3390/ijerph18010046. Full text in Research Archive

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• Lupattelli, Angela (2022). Prenatal Exposure to Antidepressants and Risk of Overweight and Obesity in Offspring at Age 8 Years. .
• Lupattelli, Angela (2022). Association of Prenatal Antidepressant Exposure with Trajectories and Acceleration of Body Mass Index in Children from 6 Weeks to 8 Years of Age.
• Lupattelli, Angela (2022). Long-term safety of antidepressants in pregnancy on metabolic health outcomes in offspring.
• Lupattelli, Angela (2022). Antidepressant Continuation and Adherence in Pregnancy and Risk of Antenatal Hospital Admission for Depression and/or Anxiety.
• Lupattelli, Angela (2022). Decisional conflict about antidepressant treatment in pregnant women with a mental illness in Norway.
• Lupattelli, Angela & Nordeng, Hedvig Marie Egeland (2021). Does antidepressant use in pregnancy increase the risk of ADHD in children? BestPractice nordic.

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