Selective serotonin reuptake inhibitors (SSRIs) in women of reproductive age: a systematic review of local formularies
Selective serotonin reuptake inhibitors (SSRIs) in women of reproductive age: a systematic review of local formularies
BACKGROUND: Depression is the second most common chronic condition affecting women of reproductive age; 23.4% of women enter pregnancy with depression and use of selective serotonin reuptake inhibitors (SSRIs) in pregnancy is often necessary for maternal wellbeing. However, SSRI use during pregnancy can cause congenital malformations, postpartum haemorrhage (PPH), and persistent pulmonary hypertension of the newborn (PPHN). In UK primary care, prescribing formularies are one medium by which prescribers are provided with local medicines advice.
AIM: To review all local prescribing formularies with respect to prescribing SSRIs in women of reproductive age, during pregnancy, and during breastfeeding.
DESIGN & SETTING: A systematic review of prescribing formularies in England and Wales.
METHOD: A systematic keyword search of all clinical commissioning group and Integrated Care Board websites in England and Local Health Board websites in Wales was undertaken between December 2021-22 to identify prescribing formularies. Data were extracted on prescribing guidance for SSRIs.
RESULTS: Seventy-four prescribing formularies were reviewed. Of these, 14.9% (
n = 11/74) provided links to the Medicines and Healthcare products Regulatory Agency guidance on congenital abnormalities associated with SSRIs, 28.4% (
n = 21/74) provided links to guidance on PPH risk, and 1.4% (
n = 1/74) provided links to guidance on PPHN. Specific local guidance was given on SSRI prescribing for women of reproductive age, during pregnancy, and during breastfeeding in 12.2% (
n = 9/74), 23.0% (
n = 17/74), and 21.6% (
n = 16/74) of formularies, respectively.
CONCLUSION: Our results suggest that prescribers may be poorly informed by local formularies about the risks of SSRI use around pregnancy. This could place babies at increased risk of unintentional SSRI exposure.
anxiety, breast feeding, depression, general practitioners, maternal health, obstetrics, postpartum period, pregnancy, primary healthcare, selective serotonin reuptake inhibitors
1-10
Lovegrove, Elizabeth
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Maidwell-Smith, Alice
0ecddf8b-0b0c-405c-a30d-66fa512a4c9e
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
July 2024
Lovegrove, Elizabeth
d7b61630-099a-4faf-94a8-10506cc9887c
Maidwell-Smith, Alice
0ecddf8b-0b0c-405c-a30d-66fa512a4c9e
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Lovegrove, Elizabeth, Maidwell-Smith, Alice, Stuart, Beth and Santer, Miriam
(2024)
Selective serotonin reuptake inhibitors (SSRIs) in women of reproductive age: a systematic review of local formularies.
BJGP Open, 8 (2), , [BJGPO.2023.0255].
(doi:10.3399/BJGPO.2023.0255).
Abstract
BACKGROUND: Depression is the second most common chronic condition affecting women of reproductive age; 23.4% of women enter pregnancy with depression and use of selective serotonin reuptake inhibitors (SSRIs) in pregnancy is often necessary for maternal wellbeing. However, SSRI use during pregnancy can cause congenital malformations, postpartum haemorrhage (PPH), and persistent pulmonary hypertension of the newborn (PPHN). In UK primary care, prescribing formularies are one medium by which prescribers are provided with local medicines advice.
AIM: To review all local prescribing formularies with respect to prescribing SSRIs in women of reproductive age, during pregnancy, and during breastfeeding.
DESIGN & SETTING: A systematic review of prescribing formularies in England and Wales.
METHOD: A systematic keyword search of all clinical commissioning group and Integrated Care Board websites in England and Local Health Board websites in Wales was undertaken between December 2021-22 to identify prescribing formularies. Data were extracted on prescribing guidance for SSRIs.
RESULTS: Seventy-four prescribing formularies were reviewed. Of these, 14.9% (
n = 11/74) provided links to the Medicines and Healthcare products Regulatory Agency guidance on congenital abnormalities associated with SSRIs, 28.4% (
n = 21/74) provided links to guidance on PPH risk, and 1.4% (
n = 1/74) provided links to guidance on PPHN. Specific local guidance was given on SSRI prescribing for women of reproductive age, during pregnancy, and during breastfeeding in 12.2% (
n = 9/74), 23.0% (
n = 17/74), and 21.6% (
n = 16/74) of formularies, respectively.
CONCLUSION: Our results suggest that prescribers may be poorly informed by local formularies about the risks of SSRI use around pregnancy. This could place babies at increased risk of unintentional SSRI exposure.
Text
BJGPO.2023.0255.full
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More information
Accepted/In Press date: 17 January 2024
e-pub ahead of print date: 25 January 2024
Published date: July 2024
Additional Information:
For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Keywords:
anxiety, breast feeding, depression, general practitioners, maternal health, obstetrics, postpartum period, pregnancy, primary healthcare, selective serotonin reuptake inhibitors
Identifiers
Local EPrints ID: 488379
URI: http://eprints.soton.ac.uk/id/eprint/488379
ISSN: 2398-3795
PURE UUID: c5ad8c4d-55e3-4a3a-82de-0b388f5ab7e6
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Date deposited: 21 Mar 2024 17:34
Last modified: 09 Nov 2024 02:43
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Author:
Alice Maidwell-Smith
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