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Antipsychotic drug use in pregnancy: A multinational study from ten countries

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  • Johan Reutfors, Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. Electronic address: johan.reutfors@ki.se.
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  • Carolyn E Cesta, Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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  • Jacqueline M Cohen, Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, 0213, Norway.
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  • Brian T Bateman, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America; Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's, Harvard Medical School, Boston, MA, United States of America.
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  • Ruth Brauer, Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
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  • Kristjana Einarsdóttir, Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
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  • Anders Engeland, Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway; Department of Global Public Health and Primary Care, University of Bergen, Norway.
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  • Kari Furu, Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, 0213, Norway.
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  • Mika Gissler, Finnish Institute for Health and Welfare, Helsinki, Finland; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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  • Alys Havard, Centre for Big Data Research in Health, Faculty of Medicine, UNSW, Sydney, Australia.
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  • Sonia Hernandez-Diaz, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
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  • Krista F Huybrechts, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America.
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  • Øystein Karlstad, Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, 0213, Norway.
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  • Maarit K Leinonen, Department of Public Health Solutions, Finnish Institute for Health and Welfare, PO Box 30, FI-00271 Helsinki, Finland.
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  • Jiong Li
  • Kenneth K C Man, Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Erasmus University Medical Centre, Rotterdam, The Netherlands.
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  • Laura Pazzagli, Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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  • Andrea Schaffer, Centre for Big Data Research in Health, Faculty of Medicine, UNSW, Sydney, Australia.
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  • Tania Schink, Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany.
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  • Zixuan Wang, Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
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  • Yongfu Yu
  • Helga Zoega, Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Centre for Big Data Research in Health, Faculty of Medicine, UNSW, Sydney, Australia.
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  • Gabriella Bröms, Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Internal Medicine, Danderyd Hospital, Stockholm, Sweden.

AIM: To compare the prevalence and trends of antipsychotic drug use during pregnancy between countries across four continents.

METHODS: Individually linked health data in Denmark (2000-2012), Finland (2005-2014), Iceland (2004-2017), Norway (2005-2015), Sweden (2006-2015), Germany (2006-2015), Australia (New South Wales, 2004-2012), Hong Kong (2001-2015), UK (2006-2016), and the US (Medicaid, 2000-2013, and IBM MarketScan, 2012-2015) were used. Using a uniformed approach, we estimated the prevalence of antipsychotic use as the proportion of pregnancies where a woman filled at least one antipsychotic prescription within three months before pregnancy until birth. For the Nordic countries, data were meta-analyzed to investigate maternal characteristics associated with the use of antipsychotics.

RESULTS: We included 8,394,343 pregnancies. Typical antipsychotic use was highest in the UK (4.4%) whereas atypical antipsychotic use was highest in the US Medicaid (1.5%). Atypical antipsychotic use increased over time in most populations, reaching 2% in Australia (2012) and US Medicaid (2013). In most countries, prochlorperazine was the most commonly used typical antipsychotic and quetiapine the most commonly used atypical antipsychotic. Use of antipsychotics decreased across the trimesters of pregnancy in all populations except Finland. Antipsychotic use was elevated among smokers and those with parity ≥4 in the Nordic countries.

CONCLUSION: Antipsychotic use during pregnancy varied considerably between populations, partly explained by varying use of the typical antipsychotic prochlorperazine, which is often used for nausea and vomiting in early pregnancy. Increasing usage of atypical antipsychotics among pregnant women reflects the pattern that was previously reported for the general population.

Original languageEnglish
JournalSchizophrenia Research
Volume220
Pages (from-to)106-115
ISSN0920-9964
DOIs
Publication statusPublished - Jun 2020

Bibliographical note

Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.

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