SSRIs in women of reproductive age; a systematic review of local formularies
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, post-partum 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: prescribing formularies in England and Wales.
Method: a systematic keyword search of all Clinical Commissioning Group (CCG) and Integrated Care Board (ICB) websites in England and Local Health Board (LHB) websites in Wales was undertaken between December 2021-22 to identify prescribing formularies. Data were extracted on prescribing guidance for SSRIs.
Results: 74 prescribing formularies were reviewed. 14.9% (11/74) provided links to the Medicines and Healthcare Regulatory products Agency guidance on congenital abnormalities associated with SSRIs, 28.4% (21/74) to guidance on PPH risk and 1.4% (1/74) 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% (9/74), 23% (17/74) and 21.6% (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 may place babies at increased risk of unintentional SSRI exposure.
Lovegrove, Elizabeth
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Maidwell-Smith, Alice
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Stuart, Beth
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Santer, Miriam
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25 January 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)
SSRIs in women of reproductive age; a systematic review of local formularies.
BJGP Open, [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, post-partum 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: prescribing formularies in England and Wales.
Method: a systematic keyword search of all Clinical Commissioning Group (CCG) and Integrated Care Board (ICB) websites in England and Local Health Board (LHB) websites in Wales was undertaken between December 2021-22 to identify prescribing formularies. Data were extracted on prescribing guidance for SSRIs.
Results: 74 prescribing formularies were reviewed. 14.9% (11/74) provided links to the Medicines and Healthcare Regulatory products Agency guidance on congenital abnormalities associated with SSRIs, 28.4% (21/74) to guidance on PPH risk and 1.4% (1/74) 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% (9/74), 23% (17/74) and 21.6% (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 may place babies at increased risk of unintentional SSRI exposure.
Text
BJGPO.2023.0255.full
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Accepted/In Press date: 17 January 2024
e-pub ahead of print date: 25 January 2024
Published date: 25 January 2024
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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.
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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: 02 May 2024 01:41
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Author:
Alice Maidwell-Smith
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