CHARACTERISTICS OF PHARMACOTHERAPY DURING PREGNANCY AND NON-PREGNANCY IN PATIENTS WITH PSYCHIATRIC DISORDERS: A PRELIMINARY COMPARISON

"The Guide for the Care of Pregnant Women with or Potentially With Psychiatric Disorders" developed by the Japanese Society of Psychiatry and Neurology recommends that the number of perinatal mother's prescriptions should be kept to a minimum one, but in real-world practice, it is not known which classes of medication are more likely to be changed after pregnancy in patients with psychiatric disorders after pregnancy.

In this study, we used a prescription database to compare the medication regimens of patients who became pregnant / were pregnant with those of non-pregnant patients. The study was approved by the Ethics Committee of the Jikei University School of Medicine.

This database study was conducted using the prescription database (JP4DR) of patients who visited the outpatient section of the Department of Psychiatry, The Jikei University Hospital as outpatients between January 1, 2018 and December 31, 2021. Fifty-two patients who became pregnant/were pregnant during the study periods were selected, and 52 non-pregnant patients were selected from the same database according to propensity scores matching for age, sex, and diagnosis. We then compared the prescriptions of antipsychotics, antidepressants, anxiolytic hypnotics, and mood stabilizers between the pregnant and nonpregnant patient groups, as well as the imipramine equivalent, chlorpromazine equivalent, and diazepam equivalent of the anxiolytics and hypnotics. A t-test was used to compare continuous amounts, and a chi-square test was used for categorical variables, both at a 5% level of significance.

Among all patients, the pregnant patient group had a significantly lower prescription rate for anxiolytics and hypnotics than the non-pregnant group(p=4.0×10-3), but there was no significant difference in the diazepam equivalents among those taking the medications(p=9.22×10-1). Subgroup analysis showed a significant difference in the prescription rate of anxiolytics and hypnotics in patients with depressive disorders(N=20), and showed a lower prescription rates of antidepressants in the pregnant group, although this did not reach significance(p=5.5×10-2). There were no significant differences in the prescription rate of mood stabilizers (p=2.0×10-1 for lithium carbamate, p=6.3×10-2 for mood stabilizers).

The study suggests that psychiatrists could discontinue anxiolytics and hypnotics after pregnancy. Further research on the low prescription rate of antidepressants would be needed from the perspective of the appropriate use of psychotropic medications in pregnant women as recommended in the "The Guide for the Care of Pregnant Women with or Potentially with Psychiatric Disorders".